Provider Demographics
NPI:1124129028
Name:LAFUZE, LEANNE MARIE (PT)
Entity type:Individual
Prefix:
First Name:LEANNE
Middle Name:MARIE
Last Name:LAFUZE
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8282 THOROUGHBRED CT
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46278-1278
Mailing Address - Country:US
Mailing Address - Phone:317-258-6861
Mailing Address - Fax:
Practice Address - Street 1:8770 COMMERCE PARK PL STE E
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46268-3128
Practice Address - Country:US
Practice Address - Phone:317-322-1300
Practice Address - Fax:219-237-9869
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-26
Last Update Date:2020-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN05005625A225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200219750Medicaid