MEDICARE: ASHLEY DAWN LEIDENHEIMER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225200000X	Physical Therapy Assistant	A-0975	NV

General Provider Information

NPI Number	:	1497261804
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ASHLEY DAWN LEIDENHEIMER

Provider Business Mailing Address
First Line	:	3831 W CHARLESTON BLVD
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89102-1859
Country	:	US
Telephone Number	:	702-876-1733
Fax Number	:

Provider Business Practice Location Address
First Line	:	8925 W RUSSELL RD STE 140
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89148-1220
Country	:	US
Telephone Number	:	702-914-6787
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/20/2017
Last Update Date	:	12/20/2017

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Directions to “ ASHLEY DAWN LEIDENHEIMER ” Practice Location

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