Provider Demographics
NPI:1710051453
Name:HAVILL, LEAH MARIE (PT)
Entity Type:Individual
Prefix:
First Name:LEAH
Middle Name:MARIE
Last Name:HAVILL
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 1:256 THIRD STREET
Mailing Address - Street 2:SUITE 32
Mailing Address - City:NIAGARA FALLS
Mailing Address - State:NY
Mailing Address - Zip Code:14303-1231
Mailing Address - Country:US
Mailing Address - Phone:716-282-2888
Mailing Address - Fax:716-285-1281
Practice Address - Street 1:256 THIRD STREET
Practice Address - Street 2:SUITE 32
Practice Address - City:NIAGARA FALLS
Practice Address - State:NY
Practice Address - Zip Code:14303-1231
Practice Address - Country:US
Practice Address - Phone:716-282-2888
Practice Address - Fax:716-285-1281
Is Sole Proprietor?:No
Enumeration Date:2006-11-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0276251225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY000628315001OtherBCBS
NY9313234OtherIHA INDEPENDENT HEALTH
NY02730418Medicaid
NY02730418Medicaid