Provider Demographics
NPI:1083459093
Name:PAHATI, LEAH CAMILLE CORDA (PT, DPT)
Entity type:Individual
Prefix:
First Name:LEAH CAMILLE
Middle Name:CORDA
Last Name:PAHATI
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1904 1ST AVE APT 10
Mailing Address - Street 2:
Mailing Address - City:STERLING
Mailing Address - State:IL
Mailing Address - Zip Code:61081-1284
Mailing Address - Country:US
Mailing Address - Phone:732-685-0370
Mailing Address - Fax:
Practice Address - Street 1:612 W SAINT MARYS RD
Practice Address - Street 2:
Practice Address - City:STERLING
Practice Address - State:IL
Practice Address - Zip Code:61081-9040
Practice Address - Country:US
Practice Address - Phone:815-626-9020
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-01
Last Update Date:2024-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY047746225100000X
IL070028105225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist