Provider Demographics
NPI:1386288215
Name:RAUCH, LEAH (LAT, ATC)
Entity type:Individual
Prefix:
First Name:LEAH
Middle Name:
Last Name:RAUCH
Suffix:
Gender:F
Credentials:LAT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26965 DOGRIDGE RD
Mailing Address - Street 2:
Mailing Address - City:BROOKVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47012-9091
Mailing Address - Country:US
Mailing Address - Phone:513-375-3760
Mailing Address - Fax:
Practice Address - Street 1:1 WILDCAT LN
Practice Address - Street 2:
Practice Address - City:BROOKVILLE
Practice Address - State:IN
Practice Address - Zip Code:47012-8100
Practice Address - Country:US
Practice Address - Phone:765-647-4101
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-04
Last Update Date:2019-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN36002448A2255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer