Provider Demographics
NPI:1821090291
Name:GREGG, LEANNE WEEMS (PT)
Entity Type:Individual
Prefix:MRS
First Name:LEANNE
Middle Name:WEEMS
Last Name:GREGG
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 1:287 WASHINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:NEWPORT
Mailing Address - State:TN
Mailing Address - Zip Code:37821-4033
Mailing Address - Country:US
Mailing Address - Phone:423-613-5924
Mailing Address - Fax:
Practice Address - Street 1:413 W BROADWAY
Practice Address - Street 2:
Practice Address - City:NEWPORT
Practice Address - State:TN
Practice Address - Zip Code:37821-2219
Practice Address - Country:US
Practice Address - Phone:423-623-7777
Practice Address - Fax:423-623-0707
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-15
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNPT1598225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3135977OtherBCBS PROVIDER NUMBER
TN3651982Medicaid
TN3651982Medicaid