Provider Demographics
NPI:1508829987
Name:EDWARDS, LEANNE ELIZABETH (MA, LAT, ATC)
Entity Type:Individual
Prefix:MS
First Name:LEANNE
Middle Name:ELIZABETH
Last Name:EDWARDS
Suffix:
Gender:F
Credentials:MA, LAT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:405 HERITAGE DR
Mailing Address - Street 2:
Mailing Address - City:HARLEYSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:19438-3958
Mailing Address - Country:US
Mailing Address - Phone:931-252-2534
Mailing Address - Fax:
Practice Address - Street 1:4050 S 26TH ST STE 140
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19112-1613
Practice Address - Country:US
Practice Address - Phone:267-463-2288
Practice Address - Fax:215-468-2789
Is Sole Proprietor?:No
Enumeration Date:2006-04-07
Last Update Date:2014-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PART0038592255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer