Provider Demographics
NPI:1922609858
Name:LEAHY, ANN MARIE
Entity Type:Individual
Prefix:
First Name:ANN MARIE
Middle Name:
Last Name:LEAHY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:65 MILL CREEK RD
Mailing Address - Street 2:
Mailing Address - City:SOUTH CHATHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02659-1619
Mailing Address - Country:US
Mailing Address - Phone:774-722-0255
Mailing Address - Fax:
Practice Address - Street 1:935 MAIN ST
Practice Address - Street 2:
Practice Address - City:CHATHAM
Practice Address - State:MA
Practice Address - Zip Code:02633-1821
Practice Address - Country:US
Practice Address - Phone:774-722-0255
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-06
Last Update Date:2020-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA12307225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist