Provider Demographics
NPI:1194063545
Name:LEADBEATER, MARY ANN
Entity type:Individual
Prefix:MRS
First Name:MARY
Middle Name:ANN
Last Name:LEADBEATER
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 1:385 SMITHFIELD HIGHHOUSE RD
Mailing Address - Street 2:
Mailing Address - City:SMITHFIELD
Mailing Address - State:PA
Mailing Address - Zip Code:15478-1237
Mailing Address - Country:US
Mailing Address - Phone:724-710-8885
Mailing Address - Fax:724-569-1068
Practice Address - Street 1:385 SMITHFIELD HIGHHOUSE RD
Practice Address - Street 2:
Practice Address - City:SMITHFIELD
Practice Address - State:PA
Practice Address - Zip Code:15478-1237
Practice Address - Country:US
Practice Address - Phone:724-710-8885
Practice Address - Fax:724-569-1068
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-18
Last Update Date:2013-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA11313601251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA11313601OtherCERTIFICATE OF LICENSURE