Healthcare Provider Details

I. General information

NPI: 1275256935
Provider Name (Legal Business Name): LEAH SURETTE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/19/2022
Last Update Date: 09/19/2022
Certification Date: 09/19/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

37 FRIEND ST
LYNN MA
01902-3068
US

IV. Provider business mailing address

5 NADINE LN
NORTH ANDOVER MA
01845-5932
US

V. Phone/Fax

Practice location:
  • Phone: 617-966-2312
  • Fax:
Mailing address:
  • Phone: 617-966-2312
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number6310
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: