Provider Demographics
NPI:1265738199
Name:MINNE, LEAH L (PTA)
Entity type:Individual
Prefix:MS
First Name:LEAH
Middle Name:L
Last Name:MINNE
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:80079 RD 444
Mailing Address - Street 2:
Mailing Address - City:BROKEN BOW
Mailing Address - State:NE
Mailing Address - Zip Code:68822-5558
Mailing Address - Country:US
Mailing Address - Phone:308-870-0969
Mailing Address - Fax:
Practice Address - Street 1:80079 RD 444
Practice Address - Street 2:
Practice Address - City:BROKEN BOW
Practice Address - State:NE
Practice Address - Zip Code:68822-5558
Practice Address - Country:US
Practice Address - Phone:308-870-0969
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-10
Last Update Date:2011-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE917225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant