Provider Demographics
NPI:1982931119
Name:PEARSON, LEANNE NIKOLE (PTA)
Entity Type:Individual
Prefix:MRS
First Name:LEANNE
Middle Name:NIKOLE
Last Name:PEARSON
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 1:3251 BAGNELL DAM BLVD
Mailing Address - Street 2:PMB 275
Mailing Address - City:LAKE OZARK
Mailing Address - State:MO
Mailing Address - Zip Code:65049-9745
Mailing Address - Country:US
Mailing Address - Phone:573-302-4446
Mailing Address - Fax:
Practice Address - Street 1:3649 HIGHWAY 54
Practice Address - Street 2:
Practice Address - City:OSAGE BEACH
Practice Address - State:MO
Practice Address - Zip Code:65065-8697
Practice Address - Country:US
Practice Address - Phone:573-302-4446
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-11-09
Last Update Date:2009-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2000152507225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant