Provider Demographics
NPI:1427529510
Name:POMINVILLE, LEANNE MARIE
Entity type:Individual
Prefix:
First Name:LEANNE
Middle Name:MARIE
Last Name:POMINVILLE
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 1:8190 TWILIGHT DR
Mailing Address - Street 2:
Mailing Address - City:BRIGHTON
Mailing Address - State:MI
Mailing Address - Zip Code:48116-8545
Mailing Address - Country:US
Mailing Address - Phone:810-333-3383
Mailing Address - Fax:
Practice Address - Street 1:8190 TWILIGHT DR
Practice Address - Street 2:
Practice Address - City:BRIGHTON
Practice Address - State:MI
Practice Address - Zip Code:48116-8545
Practice Address - Country:US
Practice Address - Phone:810-333-3383
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-12-16
Last Update Date:2018-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501003041225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist