Provider Demographics
NPI:1700040847
Name:SHOEMAKER, LEAH (PT)
Entity Type:Individual
Prefix:MRS
First Name:LEAH
Middle Name:
Last Name:SHOEMAKER
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6488 WARWICK CIR
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22315-3662
Mailing Address - Country:US
Mailing Address - Phone:505-453-5253
Mailing Address - Fax:
Practice Address - Street 1:6488 WARWICK CIR
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22315-3662
Practice Address - Country:US
Practice Address - Phone:505-453-5253
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-07-17
Last Update Date:2010-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305204915225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist