Provider Demographics
NPI:1992351100
Name:LEIVA, LAUREN ASHLEIGH (DPT)
Entity type:Individual
Prefix:
First Name:LAUREN
Middle Name:ASHLEIGH
Last Name:LEIVA
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3220 COCONUT GROVE RD
Mailing Address - Street 2:
Mailing Address - City:LAND O LAKES
Mailing Address - State:FL
Mailing Address - Zip Code:34639-6735
Mailing Address - Country:US
Mailing Address - Phone:813-464-0313
Mailing Address - Fax:
Practice Address - Street 1:15049 BRUCE B DOWNS BLVD
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33647-1388
Practice Address - Country:US
Practice Address - Phone:813-563-7668
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-13
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL34543225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
0000OtherNOT APPLICABLE