Provider Demographics
NPI:1689391740
Name:RIGDON, LEAH (PTA)
Entity Type:Individual
Prefix:
First Name:LEAH
Middle Name:
Last Name:RIGDON
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2670 SCARLET SAGE RD SW
Mailing Address - Street 2:
Mailing Address - City:LOS LUNAS
Mailing Address - State:NM
Mailing Address - Zip Code:87031-6488
Mailing Address - Country:US
Mailing Address - Phone:505-264-8992
Mailing Address - Fax:
Practice Address - Street 1:1400 MAIN ST NW STE 1&2
Practice Address - Street 2:
Practice Address - City:LOS LUNAS
Practice Address - State:NM
Practice Address - Zip Code:87031-4812
Practice Address - Country:US
Practice Address - Phone:505-865-4368
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-20
Last Update Date:2022-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMPTA1061225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant