Individual
LEAH NISSLE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MA, ATC
Contact information
Practice address
3141 CHESTNUT ST, PHILADELPHIA, PA 19104-2875
(215) 895-1597
Mailing address
3141 CHESTNUT ST, PHILADELPHIA, PA 19104-2875
(215) 895-1597
(215) 895-1943
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
RT005715
PA
Other
Enumeration date
07/10/2019
Last updated
07/10/2019
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