Healthcare Provider Details

I. General information

NPI: 1972326106
Provider Name (Legal Business Name): MITCHELL REID LEFFLER
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/05/2024
Last Update Date: 11/05/2024
Certification Date: 11/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1515 LAKE LANSING RD
LANSING MI
48912-3753
US

IV. Provider business mailing address

148 S MAIN ST
LESLIE MI
49251-2561
US

V. Phone/Fax

Practice location:
  • Phone: 517-507-0405
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number5502007961
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: