Individual
LEAH L HAVERHALS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PT
Contact information
Practice address
301 HIGHWAY 65 S, MORA, MN 55051-1899
(320) 225-3356
Mailing address
301 HIGHWAY 65 S, MORA, MN 55051-1899
(320) 225-3356
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
070016387
IL
225100000X
Physical Therapist
Primary
10602
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
P01094077
RR MEDICARE
IL
Enumeration date
07/27/2012
Last updated
01/31/2018
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