Provider Demographics
NPI:1578596128
Name:LEAHY PROSTHETICS & ORTHOTICS INC
Entity Type:Organization
Organization Name:LEAHY PROSTHETICS & ORTHOTICS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:M
Authorized Official - Last Name:LEAHY
Authorized Official - Suffix:
Authorized Official - Credentials:CP
Authorized Official - Phone:831-425-5900
Mailing Address - Street 1:630 FREDERICK ST
Mailing Address - Street 2:
Mailing Address - City:SANTA CRUZ
Mailing Address - State:CA
Mailing Address - Zip Code:95062
Mailing Address - Country:US
Mailing Address - Phone:831-425-5900
Mailing Address - Fax:831-425-0488
Practice Address - Street 1:630 FREDERICK ST
Practice Address - Street 2:
Practice Address - City:SANTA CRUZ
Practice Address - State:CA
Practice Address - Zip Code:95062-2203
Practice Address - Country:US
Practice Address - Phone:831-425-5900
Practice Address - Fax:831-425-0488
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CACP2178224P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes224P00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersProsthetistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
XB0021780OtherCENTRAL COAST ALLIANCE FO
XB0021780OtherCENTRAL COAST ALLIANCE FO