MEDICARE: PATTY LEYSHOCK RD

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	133V00000X	Registered Dietitian	DN000290	PA

General Provider Information

NPI Number	:	1366485526
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PATTY LEYSHOCK RD

Provider Business Mailing Address
First Line	:	309 CHURCHILL DR
Second Line	:
City	:	GREENSBURG
State	:	PA
Zip	:	15601-1078
Country	:	US
Telephone Number	:	724-836-8186
Fax Number	:

Provider Business Practice Location Address
First Line	:	UNIONTOWN HOSPITAL
Second Line	:	500 WEST BERKELEY STREET
City	:	UNIONTOWN
State	:	PA
Zip	:	15401
Country	:	US
Telephone Number	:	724-430-5052
Fax Number	:

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

Provider Enumeration Date	:	06/14/2006
Last Update Date	:	07/08/2007

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