Provider Demographics
NPI:1841490448
Name:LEAVER-DUNN, DEIDRE DIANNE (PHD, LAT, ATC)
Entity type:Individual
Prefix:DR
First Name:DEIDRE
Middle Name:DIANNE
Last Name:LEAVER-DUNN
Suffix:
Gender:F
Credentials:PHD, LAT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 870311
Mailing Address - Street 2:
Mailing Address - City:TUSCALOOSA
Mailing Address - State:AL
Mailing Address - Zip Code:35487-0311
Mailing Address - Country:US
Mailing Address - Phone:205-348-9176
Mailing Address - Fax:205-348-7568
Practice Address - Street 1:SORORITY CIRCLE
Practice Address - Street 2:THE UNIVERSITY OF ALABAMA
Practice Address - City:TUSCALOOSA
Practice Address - State:AL
Practice Address - Zip Code:35487-0001
Practice Address - Country:US
Practice Address - Phone:205-348-9176
Practice Address - Fax:205-348-7568
Is Sole Proprietor?:No
Enumeration Date:2007-07-20
Last Update Date:2010-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL0602255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer