Provider Demographics
NPI:1598200081
Name:LEEGE, BRITNEY ANN (PTA)
Entity Type:Individual
Prefix:MRS
First Name:BRITNEY
Middle Name:ANN
Last Name:LEEGE
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:MISS
Other - First Name:BRITNEY
Other - Middle Name:ANN
Other - Last Name:SCHULTZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PTA
Mailing Address - Street 1:N9474 COUNTY ROAD O
Mailing Address - Street 2:
Mailing Address - City:WISCONSIN DELLS
Mailing Address - State:WI
Mailing Address - Zip Code:53965
Mailing Address - Country:US
Mailing Address - Phone:608-377-2777
Mailing Address - Fax:
Practice Address - Street 1:N9474 COUNTY ROAD O
Practice Address - Street 2:
Practice Address - City:WISCONSIN DELLS
Practice Address - State:WI
Practice Address - Zip Code:53965
Practice Address - Country:US
Practice Address - Phone:608-377-2777
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-12-20
Last Update Date:2018-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2300-19225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant