Healthcare Provider Details

I. General information

NPI: 1457442873
Provider Name (Legal Business Name): LEAH MCCONNELL MHSPT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/28/2006
Last Update Date: 01/21/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

751 SEEWEE BLUFF RD
AWENDAW SC
29429-6061
US

IV. Provider business mailing address

751 SEEWEE BLUFF RD
AWENDAW SC
29429-6061
US

V. Phone/Fax

Practice location:
  • Phone: 843-670-7246
  • Fax:
Mailing address:
  • Phone: 843-670-7246
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number3974
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: