Healthcare Provider Details

I. General information

NPI: 1306991435
Provider Name (Legal Business Name): CLAUDE I LEIGH RRT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/25/2007
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1058 POPLAR CIR
WESTON FL
33326-2845
US

IV. Provider business mailing address

1058 POPLAR CIR
WESTON FL
33326-2845
US

V. Phone/Fax

Practice location:
  • Phone: 954-389-8612
  • Fax:
Mailing address:
  • Phone: 954-389-8612
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2279H0200X
TaxonomyHome Health Registered Respiratory Therapist
License NumberRT0002247
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: