Provider Demographics
NPI:1124415682
Name:ENGLAND, LEAH
Entity type:Individual
Prefix:
First Name:LEAH
Middle Name:
Last Name:ENGLAND
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4809 N SHERIDAN RD
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:IL
Mailing Address - Zip Code:61614-5927
Mailing Address - Country:US
Mailing Address - Phone:309-685-5777
Mailing Address - Fax:309-685-5779
Practice Address - Street 1:4809 N SHERIDAN RD
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:IL
Practice Address - Zip Code:61614-5927
Practice Address - Country:US
Practice Address - Phone:309-685-5777
Practice Address - Fax:309-685-5779
Is Sole Proprietor?:No
Enumeration Date:2015-04-22
Last Update Date:2015-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL227.010489225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist