Provider Demographics
NPI:1497492821
Name:GRIFFITT, LEISHA LYNETTE (LAT,ATC)
Entity Type:Individual
Prefix:
First Name:LEISHA
Middle Name:LYNETTE
Last Name:GRIFFITT
Suffix:
Gender:F
Credentials:LAT,ATC
Other - Prefix:
Other - First Name:LEISHA
Other - Middle Name:
Other - Last Name:WELLS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LAT, ATC
Mailing Address - Street 1:4601 WILDCAT DR
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:TX
Mailing Address - Zip Code:78374-2827
Mailing Address - Country:US
Mailing Address - Phone:361-777-4251
Mailing Address - Fax:
Practice Address - Street 1:4601 WILDCAT DR
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:TX
Practice Address - Zip Code:78374-2827
Practice Address - Country:US
Practice Address - Phone:361-777-4251
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-17
Last Update Date:2022-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAT69742255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer