Provider Demographics
NPI:1720217219
Name:LEAVELL, ROBIN (PTA)
Entity Type:Individual
Prefix:MRS
First Name:ROBIN
Middle Name:
Last Name:LEAVELL
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 1:400 NATURAL RESOURCES DR
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72205-1501
Mailing Address - Country:US
Mailing Address - Phone:501-687-2000
Mailing Address - Fax:
Practice Address - Street 1:400 NATURAL RESOURCES DR
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72205-1501
Practice Address - Country:US
Practice Address - Phone:501-687-2000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-06
Last Update Date:2009-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPTA 1851225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant