Individual
KELLIE ANN LEAVITT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PTA
Contact information
Practice address
21001 N TATUM BLVD STE 78-1640, PHOENIX, AZ 85050-5244
(877) 222-5348
Mailing address
4930 W TONTO RD, GLENDALE, AZ 85308-9222
(208) 241-1804
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
PTA-014015
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
PTA-014015
ARIZONA STATE BOARD OF PHYSICAL THERAPY
AZ
Enumeration date
10/17/2021
Last updated
10/17/2021
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