Provider Demographics
NPI:1265937288
Name:TINDALL, LEIANNE M
Entity type:Individual
Prefix:
First Name:LEIANNE
Middle Name:M
Last Name:TINDALL
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 1:627 MIDDLETON RD
Mailing Address - Street 2:
Mailing Address - City:WINONA
Mailing Address - State:MS
Mailing Address - Zip Code:38967-2000
Mailing Address - Country:US
Mailing Address - Phone:662-283-1260
Mailing Address - Fax:
Practice Address - Street 1:627 MIDDLETON RD
Practice Address - Street 2:
Practice Address - City:WINONA
Practice Address - State:MS
Practice Address - Zip Code:38967-2000
Practice Address - Country:US
Practice Address - Phone:662-283-1260
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-30
Last Update Date:2018-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSPTA6348225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant