Provider Demographics
NPI:1982836979
Name:POWELL, LEANN MICHELLE (CROFT) (PT, MSPT)
Entity Type:Individual
Prefix:MRS
First Name:LEANN
Middle Name:MICHELLE (CROFT)
Last Name:POWELL
Suffix:
Gender:F
Credentials:PT, MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2810 E EMPIRE ST STE B
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:IL
Mailing Address - Zip Code:61704-4200
Mailing Address - Country:US
Mailing Address - Phone:309-452-0704
Mailing Address - Fax:309-452-0555
Practice Address - Street 1:2810 E EMPIRE ST STE B
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:IL
Practice Address - Zip Code:61704-4200
Practice Address - Country:US
Practice Address - Phone:309-452-0704
Practice Address - Fax:309-452-0555
Is Sole Proprietor?:No
Enumeration Date:2009-08-10
Last Update Date:2023-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070013424225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist