Provider Demographics
NPI:1811120199
Name:LEAVENS, LEANNE
Entity type:Individual
Prefix:
First Name:LEANNE
Middle Name:
Last Name:LEAVENS
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 1:5930 HAMILTON BLVD
Mailing Address - Street 2:SUITE 110
Mailing Address - City:ALLENTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18106-9654
Mailing Address - Country:US
Mailing Address - Phone:610-398-6800
Mailing Address - Fax:
Practice Address - Street 1:5930 HAMILTON BLVD
Practice Address - Street 2:SUITE 110
Practice Address - City:ALLENTOWN
Practice Address - State:PA
Practice Address - Zip Code:18106-9654
Practice Address - Country:US
Practice Address - Phone:610-398-6800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-09-02
Last Update Date:2009-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist