Provider Demographics
NPI:1578633541
Name:CHURCH, LEANNE R (MSPT)
Entity Type:Individual
Prefix:MISS
First Name:LEANNE
Middle Name:R
Last Name:CHURCH
Suffix:
Gender:F
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:335 NEW HOPE MOUNTAIN RD
Mailing Address - Street 2:
Mailing Address - City:INDIAN SPRINGS
Mailing Address - State:AL
Mailing Address - Zip Code:35124-3719
Mailing Address - Country:US
Mailing Address - Phone:205-824-0610
Mailing Address - Fax:205-824-6243
Practice Address - Street 1:2090 COLUMBIANA RD
Practice Address - Street 2:SUITE 1000
Practice Address - City:VESTAVIA
Practice Address - State:AL
Practice Address - Zip Code:35216-2153
Practice Address - Country:US
Practice Address - Phone:205-824-0610
Practice Address - Fax:205-824-6263
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALPT1824225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL51515298OtherBLUE CROSS BLUE SHIELD