Provider Demographics
NPI:1194920348
Name:LORD, LEAH C (PT)
Entity type:Individual
Prefix:
First Name:LEAH
Middle Name:C
Last Name:LORD
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:CHARISE
Other - Middle Name:
Other - Last Name:LORD
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:3221 FREDERICA ST
Mailing Address - Street 2:STE B
Mailing Address - City:OWENSBORO
Mailing Address - State:KY
Mailing Address - Zip Code:42301-6086
Mailing Address - Country:US
Mailing Address - Phone:270-926-2212
Mailing Address - Fax:270-926-2215
Practice Address - Street 1:3221 FREDERICA ST
Practice Address - Street 2:STE B
Practice Address - City:OWENSBORO
Practice Address - State:KY
Practice Address - Zip Code:42301-6086
Practice Address - Country:US
Practice Address - Phone:270-926-2212
Practice Address - Fax:270-926-2215
Is Sole Proprietor?:No
Enumeration Date:2007-06-18
Last Update Date:2016-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3772225100000X
KY001095225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
0782MOtherBCBS PIN