Provider Demographics
NPI:1558566521
Name:LEACH, CLIFFORD MATTHEW (DPT)
Entity Type:Individual
Prefix:
First Name:CLIFFORD
Middle Name:MATTHEW
Last Name:LEACH
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:MATT
Other - Middle Name:
Other - Last Name:LEACH
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DPT
Mailing Address - Street 1:6045 ALMA RD
Mailing Address - Street 2:STE 320
Mailing Address - City:MCKINNEY
Mailing Address - State:TX
Mailing Address - Zip Code:75070-2188
Mailing Address - Country:US
Mailing Address - Phone:972-569-9050
Mailing Address - Fax:972-569-9076
Practice Address - Street 1:6045 ALMA DR
Practice Address - Street 2:STE 320
Practice Address - City:MCKINNEY
Practice Address - State:TX
Practice Address - Zip Code:75070
Practice Address - Country:US
Practice Address - Phone:972-569-9050
Practice Address - Fax:972-569-9076
Is Sole Proprietor?:No
Enumeration Date:2007-06-19
Last Update Date:2010-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1172280225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX207749701Medicaid
TX824T43OtherBCBS
TX8T7285OtherBCBS
TX207749701Medicaid
TX8F23030Medicare PIN