Healthcare Provider Details

I. General information

NPI: 1699205195
Provider Name (Legal Business Name): MORGAN LYNN LEYBA DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/15/2017
Last Update Date: 01/18/2021
Certification Date: 01/18/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3905 E GRAND AVE STE 200
LARAMIE WY
82070-5189
US

IV. Provider business mailing address

4203 MORAINE ST
LARAMIE WY
82070-5719
US

V. Phone/Fax

Practice location:
  • Phone: 307-742-2082
  • Fax:
Mailing address:
  • Phone: 307-299-0493
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT-1714
License Number StateWY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: