MEDICARE: DIANNE LEACH NP

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
1	208100000X	Physical Medicine & Rehabilitation Physician	71002649B	IN

General Provider Information

NPI Number	:	1346400942
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DIANNE LEACH NP

Provider Business Mailing Address
First Line	:	3520 GUION ROAD
Second Line	:	STE 303
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46222-1692
Country	:	US
Telephone Number	:	317-920-3220
Fax Number	:	317-920-3221

Provider Business Practice Location Address
First Line	:	3520 GUION ROAD
Second Line	:	STE 303
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46222-1692
Country	:	US
Telephone Number	:	317-920-3220
Fax Number	:	317-920-3221

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/17/2008
Last Update Date	:	03/07/2023

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