Provider Demographics
NPI:1285006312
Name:LAGASSE, LEAH ELISE (DPT)
Entity type:Individual
Prefix:MRS
First Name:LEAH
Middle Name:ELISE
Last Name:LAGASSE
Suffix:
Gender:
Credentials:DPT
Other - Prefix:MS
Other - First Name:LEAH
Other - Middle Name:ELISE
Other - Last Name:MCMILLION
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:501 FOREST LANE
Mailing Address - Street 2:SUITE A
Mailing Address - City:CLEMSON
Mailing Address - State:SC
Mailing Address - Zip Code:29631
Mailing Address - Country:US
Mailing Address - Phone:864-654-2001
Mailing Address - Fax:800-305-7112
Practice Address - Street 1:9251 STONESTREET RD
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40272-2858
Practice Address - Country:US
Practice Address - Phone:877-407-3422
Practice Address - Fax:877-407-4329
Is Sole Proprietor?:No
Enumeration Date:2015-10-28
Last Update Date:2025-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIPT4089225100000X
SC9232225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCTH3760Medicaid