Provider Demographics
NPI:1861661829
Name:SANDER, LEAH MICHELE (PT)
Entity Type:Individual
Prefix:MRS
First Name:LEAH
Middle Name:MICHELE
Last Name:SANDER
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 1:221 RANSOM TRCE
Mailing Address - Street 2:
Mailing Address - City:GEORGETOWN
Mailing Address - State:KY
Mailing Address - Zip Code:40324-2150
Mailing Address - Country:US
Mailing Address - Phone:502-868-0638
Mailing Address - Fax:
Practice Address - Street 1:221 RANSOM TRCE
Practice Address - Street 2:
Practice Address - City:GEORGETOWN
Practice Address - State:KY
Practice Address - Zip Code:40324-2150
Practice Address - Country:US
Practice Address - Phone:502-868-0638
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-25
Last Update Date:2008-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY0026102251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics