Provider Demographics
NPI:1790388023
Name:MAYHUGH, LEAH (PTA)
Entity Type:Individual
Prefix:
First Name:LEAH
Middle Name:
Last Name:MAYHUGH
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:LEAH
Other - Middle Name:
Other - Last Name:MANTICK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:12680 PERRY HWY
Mailing Address - Street 2:
Mailing Address - City:WEXFORD
Mailing Address - State:PA
Mailing Address - Zip Code:15090-8886
Mailing Address - Country:US
Mailing Address - Phone:724-720-4510
Mailing Address - Fax:
Practice Address - Street 1:12680 PERRY HWY
Practice Address - Street 2:
Practice Address - City:WEXFORD
Practice Address - State:PA
Practice Address - Zip Code:15090-8886
Practice Address - Country:US
Practice Address - Phone:724-720-4510
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-19
Last Update Date:2021-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PATE012597225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant