Provider Demographics
NPI:1336620848
Name:BOES, LEANZA
Entity Type:Individual
Prefix:
First Name:LEANZA
Middle Name:
Last Name:BOES
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 1:191 W 12TH AVE RM 497
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43210-1301
Mailing Address - Country:US
Mailing Address - Phone:805-905-9703
Mailing Address - Fax:
Practice Address - Street 1:535 IRVING SCHOTTENSTEIN DR
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43210-1044
Practice Address - Country:US
Practice Address - Phone:805-905-9703
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-23
Last Update Date:2018-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer