Provider Demographics
NPI:1609024116
Name:HARVEY, LEAH D (MSPT)
Entity Type:Individual
Prefix:
First Name:LEAH
Middle Name:D
Last Name:HARVEY
Suffix:
Gender:F
Credentials:MSPT
Other - Prefix:
Other - First Name:LEAH
Other - Middle Name:MELANIE
Other - Last Name:DREW
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSPT
Mailing Address - Street 1:21 JOHNNAS WAY
Mailing Address - Street 2:
Mailing Address - City:GLENBURN
Mailing Address - State:ME
Mailing Address - Zip Code:04401-1258
Mailing Address - Country:US
Mailing Address - Phone:207-356-9215
Mailing Address - Fax:866-220-5031
Practice Address - Street 1:840 HAMMOND ST STE 2
Practice Address - Street 2:
Practice Address - City:BANGOR
Practice Address - State:ME
Practice Address - Zip Code:04401-4339
Practice Address - Country:US
Practice Address - Phone:207-433-7778
Practice Address - Fax:866-220-5031
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-09
Last Update Date:2013-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPT3445225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME1609024116OtherANTHEM
MEP00677350OtherMEDICARE RAILROAD
ME000771701Medicare PIN