Provider Demographics
NPI:1306241096
Name:CLARK, LEIGH ANNE (LMT)
Entity type:Individual
Prefix:
First Name:LEIGH
Middle Name:ANNE
Last Name:CLARK
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:458 S 10TH ST
Mailing Address - Street 2:
Mailing Address - City:OPELIKA
Mailing Address - State:AL
Mailing Address - Zip Code:36801-5858
Mailing Address - Country:US
Mailing Address - Phone:334-737-1400
Mailing Address - Fax:
Practice Address - Street 1:458 S 10TH ST
Practice Address - Street 2:
Practice Address - City:OPELIKA
Practice Address - State:AL
Practice Address - Zip Code:36801-5858
Practice Address - Country:US
Practice Address - Phone:334-737-1400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-10-24
Last Update Date:2015-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL2098225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist