Provider Demographics
NPI:1912143132
Name:HARRIS, LEAH R (PT)
Entity type:Individual
Prefix:
First Name:LEAH
Middle Name:R
Last Name:HARRIS
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:LEAH
Other - Middle Name:R
Other - Last Name:MCCORMICK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MPT
Mailing Address - Street 1:4900 SANGER AVE
Mailing Address - Street 2:
Mailing Address - City:WACO
Mailing Address - State:TX
Mailing Address - Zip Code:76710-5866
Mailing Address - Country:US
Mailing Address - Phone:254-848-6284
Mailing Address - Fax:254-848-4193
Practice Address - Street 1:4900 SANGER AVE
Practice Address - Street 2:
Practice Address - City:WACO
Practice Address - State:TX
Practice Address - Zip Code:76710-5866
Practice Address - Country:US
Practice Address - Phone:254-848-6284
Practice Address - Fax:254-848-4193
Is Sole Proprietor?:No
Enumeration Date:2008-12-17
Last Update Date:2023-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1313920225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist