Provider Demographics
NPI:1811481930
Name:AMBURN, LEAH KATHRYN (PT)
Entity type:Individual
Prefix:
First Name:LEAH
Middle Name:KATHRYN
Last Name:AMBURN
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:LEAH
Other - Middle Name:KATHRYN
Other - Last Name:EVANSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:1200 CORPORATE DR STE 400
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35242-5424
Mailing Address - Country:US
Mailing Address - Phone:423-238-8930
Mailing Address - Fax:423-254-5217
Practice Address - Street 1:2497 S ROANE ST STE 220
Practice Address - Street 2:
Practice Address - City:HARRIMAN
Practice Address - State:TN
Practice Address - Zip Code:37748
Practice Address - Country:US
Practice Address - Phone:865-882-9783
Practice Address - Fax:865-882-9548
Is Sole Proprietor?:No
Enumeration Date:2018-06-21
Last Update Date:2018-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN11846225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist