Healthcare Provider Details

I. General information

NPI: 1528237310
Provider Name (Legal Business Name): LEANNE NICOLE SCHMIDT MPT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: LEANNE NICOLE HEMARD MPT

II. Dates (important events)

Enumeration Date: 02/26/2008
Last Update Date: 10/04/2022
Certification Date: 10/04/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5025 KEYSTONE BLVD STE 100
COVINGTON LA
70433-7517
US

IV. Provider business mailing address

5025 KEYSTONE BLVD STE 100
COVINGTON LA
70433-7517
US

V. Phone/Fax

Practice location:
  • Phone: 719-475-0477
  • Fax: 719-475-1021
Mailing address:
  • Phone: 504-896-3949
  • Fax: 504-962-7048

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number8782
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: