Provider Demographics
NPI:1801396684
Name:MARTIN, LEANNE (PTA)
Entity Type:Individual
Prefix:
First Name:LEANNE
Middle Name:
Last Name:MARTIN
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:LEANNE
Other - Middle Name:
Other - Last Name:MARTIN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PTA
Mailing Address - Street 1:3101 STATE ROUTE 99
Mailing Address - Street 2:
Mailing Address - City:MONROEVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:44847-9414
Mailing Address - Country:US
Mailing Address - Phone:419-706-8479
Mailing Address - Fax:
Practice Address - Street 1:196 W MAIN ST
Practice Address - Street 2:
Practice Address - City:NORWALK
Practice Address - State:OH
Practice Address - Zip Code:44857-1915
Practice Address - Country:US
Practice Address - Phone:419-668-2086
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-18
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH08332225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant