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NPI Code Detail

MEDICARE: ABBY LEIGH LEETZOW D.P.T.

MEDICARE: ABBY LEIGH LEETZOW D.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 Therapist12817-24WI

General Provider Information

NPI Number : 1841692902
Entity Type Code : Individual
Provider Name (Legal Business Name) : ABBY LEIGH LEETZOW D.P.T.
Provider Business Mailing Address
First Line : 3301 W FOREST HOME AVE
Second Line :
City : MILWAUKEE
State : WI
Zip : 53215-2843
Country : US
Telephone Number : 414-389-2233
Fax Number :
Provider Business Practice Location Address
First Line : 6263 N GREEN BAY AVE
Second Line :
City : GLENDALE
State : WI
Zip : 53209-3823
Country : US
Telephone Number : 414-351-0543
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/20/2014
Last Update Date : 09/24/2020

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