Provider Demographics
NPI:1154345213
Name:LEACH, DELEE B (PTA, ATC)
Entity type:Individual
Prefix:
First Name:DELEE
Middle Name:B
Last Name:LEACH
Suffix:
Gender:F
Credentials:PTA, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3301 BERRYWOOD DR
Mailing Address - Street 2:SUITE 204
Mailing Address - City:COLUMBIA
Mailing Address - State:MO
Mailing Address - Zip Code:65201-6517
Mailing Address - Country:US
Mailing Address - Phone:573-449-8771
Mailing Address - Fax:573-449-6563
Practice Address - Street 1:1251 S CHEROKEE DR
Practice Address - Street 2:SUITE 1
Practice Address - City:MARSHALL
Practice Address - State:MO
Practice Address - Zip Code:65340-3610
Practice Address - Country:US
Practice Address - Phone:660-831-1895
Practice Address - Fax:660-831-1898
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2003026368225200000X
MO1024482255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant
Not Answered2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer