Provider Demographics
NPI:1912009903
Name:GUY, LEAVERN (RKT)
Entity Type:Individual
Prefix:MR
First Name:LEAVERN
Middle Name:
Last Name:GUY
Suffix:
Gender:M
Credentials:RKT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:925 CLOVER CIR
Mailing Address - Street 2:
Mailing Address - City:PICAYUNE
Mailing Address - State:MS
Mailing Address - Zip Code:39466-5436
Mailing Address - Country:US
Mailing Address - Phone:601-273-1070
Mailing Address - Fax:
Practice Address - Street 1:925 CLOVER CIR
Practice Address - Street 2:
Practice Address - City:PICAYUNE
Practice Address - State:MS
Practice Address - Zip Code:39466-5436
Practice Address - Country:US
Practice Address - Phone:601-273-1070
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-01
Last Update Date:2009-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1720226300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes226300000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersKinesiotherapist