Provider Demographics
NPI:1598317729
Name:LEACH, DEANA R (LMT)
Entity Type:Individual
Prefix:
First Name:DEANA
Middle Name:R
Last Name:LEACH
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 UHRIG ST
Mailing Address - Street 2:
Mailing Address - City:HILLSBORO
Mailing Address - State:OH
Mailing Address - Zip Code:45133-1427
Mailing Address - Country:US
Mailing Address - Phone:937-402-4203
Mailing Address - Fax:937-402-4206
Practice Address - Street 1:111 UHRIG ST
Practice Address - Street 2:
Practice Address - City:HILLSBORO
Practice Address - State:OH
Practice Address - Zip Code:45133-1427
Practice Address - Country:US
Practice Address - Phone:937-402-4203
Practice Address - Fax:937-402-4206
Is Sole Proprietor?:No
Enumeration Date:2019-07-09
Last Update Date:2019-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPTA012304225200000X
OH33.022069225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
No225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant