Provider Demographics
NPI:1841692902
Name:LEETZOW, ABBY LEIGH (DPT)
Entity type:Individual
Prefix:
First Name:ABBY
Middle Name:LEIGH
Last Name:LEETZOW
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:ABBY
Other - Middle Name:LEIGH
Other - Last Name:GOOSSEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3301 W FOREST HOME AVE
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53215-2843
Mailing Address - Country:US
Mailing Address - Phone:414-389-2233
Mailing Address - Fax:
Practice Address - Street 1:6263 N GREEN BAY AVE
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:WI
Practice Address - Zip Code:53209-3823
Practice Address - Country:US
Practice Address - Phone:414-351-0543
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-09-20
Last Update Date:2020-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI12817-24225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist