Provider Demographics
NPI:1730105115
Name:LEAMER, TIFFANY A (DPT)
Entity Type:Individual
Prefix:DR
First Name:TIFFANY
Middle Name:A
Last Name:LEAMER
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:541 CATHEDRAL DR
Mailing Address - Street 2:
Mailing Address - City:APTOS
Mailing Address - State:CA
Mailing Address - Zip Code:95003-3423
Mailing Address - Country:US
Mailing Address - Phone:831-687-0264
Mailing Address - Fax:
Practice Address - Street 1:3319 MISSION DR STE B
Practice Address - Street 2:
Practice Address - City:SANTA CRUZ
Practice Address - State:CA
Practice Address - Zip Code:95065-1827
Practice Address - Country:US
Practice Address - Phone:831-465-0107
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA29813225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAOPT298130Medicare ID - Type Unspecified