Provider Demographics
NPI:1487044814
Name:SUDBURY, LEEIGH ANN (ATC, LAT)
Entity Type:Individual
Prefix:
First Name:LEEIGH ANN
Middle Name:
Last Name:SUDBURY
Suffix:
Gender:F
Credentials:ATC, LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 7001
Mailing Address - Street 2:LETOURNEAU ATHLETICS
Mailing Address - City:LONGVIEW
Mailing Address - State:TX
Mailing Address - Zip Code:75607-7001
Mailing Address - Country:US
Mailing Address - Phone:903-233-3742
Mailing Address - Fax:
Practice Address - Street 1:2100 S MOBBERLY AVE
Practice Address - Street 2:
Practice Address - City:LONGVIEW
Practice Address - State:TX
Practice Address - Zip Code:75602-3564
Practice Address - Country:US
Practice Address - Phone:903-233-3742
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-01-22
Last Update Date:2015-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAT60822255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer