Individual
NICOLE D LEACH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DPT
Contact information
Practice address
915 NE 7TH ST STE 1, BEND, OR 97701-4515
(541) 728-0974
(541) 728-0159
Mailing address
20 PARK PL STE 2, SHIPPENSBURG, PA 17257-9806
(717) 477-8030
(717) 477-8040
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
63972
OR
225100000X
Physical Therapist
PT025430
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1032649900
—
PA
Enumeration date
09/01/2016
Last updated
10/12/2022
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