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General NPI Number Information
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NPI Number | 1023224300
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Entity Type | Individual
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Provider Name | CAROL J LEACH PT PHD
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Gender | Female
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Dates
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Enumeration Date | 05/15/2007
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Last Update Date | 05/20/2010
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Provider Practice Location Address
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Address Line | 920 BARLOW RD
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City | FORT MORGAN
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State | CO
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Zip | 80701-4371
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Country | US
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Telephone | 970-542-3225
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Fax | 970-542-3115
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Provider Business Mailing Address
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Address Line | 2010 46TH AVE UNIT 49
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City | GREELEY
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State | CO
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Zip | 80634-3258
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Country | US
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Telephone | 970-397-6353
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Fax | 970-542-3115
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 548
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License Number State | CO
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