Healthcare Provider Details

I. General information

NPI: 1235043589
Provider Name (Legal Business Name): LEAH BLOCKER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/01/2026
Last Update Date: 10/01/2026
Certification Date: 10/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2845 HAMLINE AVE N
ROSEVILLE MN
55113-7127
US

IV. Provider business mailing address

2845 HAMLINE AVE N
ROSEVILLE MN
55113-7127
US

V. Phone/Fax

Practice location:
  • Phone: 651-302-0704
  • Fax:
Mailing address:
  • Phone: 651-302-0704
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0019X
TaxonomyPhysical Rehabilitation Occupational Therapist
License Number104086
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: