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General NPI Number Information
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NPI Number | 1164547956
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Entity Type | Individual
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Provider Name | WILLIAM G LEACH PHYSICAL THERAPIST
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Gender | Male
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Dates
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Enumeration Date | 03/20/2007
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Last Update Date | 04/26/2023
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Provider Practice Location Address
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Address Line | 8961 YOUREE DR
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City | SHREVEPORT
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State | LA
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Zip | 71115-3001
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Country | US
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Telephone | 318-671-8772
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Fax | 318-671-8776
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Provider Business Mailing Address
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Address Line | 8961 YOUREE DR
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City | SHREVEPORT
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State | LA
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Zip | 71115-3001
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Country | US
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Telephone | 318-671-8772
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Fax | 318-671-8776
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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 | CP010730T
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 02261
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License Number State | LA
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