# CRYSTAL LEACH, MD PHYSIATRY AND ASSOCIATES LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1568154862
- **Authorized official:** DR. CRYSTAL IVAHNA LEACH MD (MANAGER/MEMBER/OWNER/PHYSICIAN)
- **Authorized official phone:** (504) 915-3461

## Contact information

- **Practice address:** 17351 MELFORD BLVD, BOWIE, MD 20715-4457
- **Practice address phone:** (240) 548-1300
- **Practice address fax:** (240) 548-1695
- **Mailing address:** 1296 CRONSON BLVD, UNIT 4444, CROFTON, MD 21114-9998
- **Mailing address phone:** (504) 915-3461

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 208100000X | Physical Medicine & Rehabilitation Physician | — | NULL | Yes |
| 208100000X | Physical Medicine & Rehabilitation Physician | — | — | Yes |

## Other

- **Enumeration date:** 05/24/2023
- **Last updated:** 05/27/2023