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NPI Code Detail

MEDICARE: LEAH MCKENNA M.S.P.T.

MEDICARE: LEAH MCKENNA M.S.P.T.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225100000XPhysical Therapist15852MA

General Provider Information

NPI Number : 1184692824
Entity Type Code : Individual
Provider Name (Legal Business Name) : LEAH MCKENNA M.S.P.T.
Provider Business Mailing Address
First Line : 322 E CENTER ST
Second Line :
City : WEST BRIDGEWATER
State : MA
Zip : 02379-1824
Country : US
Telephone Number : 508-559-0993
Fax Number :
Provider Business Practice Location Address
First Line : 1215 BROADWAY
Second Line :
City : RAYNHAM
State : MA
Zip : 02767-1942
Country : US
Telephone Number : 508-823-3967
Fax Number : 508-823-4579
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/09/2006
Last Update Date : 07/08/2007

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