Provider Demographics
NPI:1831396068
Name:ANZALONE, LEANN A (PTA)
Entity type:Individual
Prefix:
First Name:LEANN
Middle Name:A
Last Name:ANZALONE
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 1:14819 E 22ND AVE
Mailing Address - Street 2:
Mailing Address - City:SPOKANE VALLEY
Mailing Address - State:WA
Mailing Address - Zip Code:99037-9496
Mailing Address - Country:US
Mailing Address - Phone:509-924-9840
Mailing Address - Fax:
Practice Address - Street 1:8502 N NEVADA ST
Practice Address - Street 2:#2
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99208-7395
Practice Address - Country:US
Practice Address - Phone:509-487-2958
Practice Address - Fax:509-487-3025
Is Sole Proprietor?:No
Enumeration Date:2007-06-29
Last Update Date:2007-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDPTA-2100225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
IDPTA-2100OtherID PTA LICENSE