Individual
JENNIFER LEACH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PT
Contact information
Practice address
7227 E BASELINE RD STE 106, MESA, AZ 85209-5005
(480) 823-5777
Mailing address
7242 E MONTE AVE, MESA, AZ 85209-4971
(616) 257-7902
Taxonomy
Speciality
Code
Description
License number
State
204C00000X
Sports Medicine (Neuromusculoskeletal Medicine) Physician
LPT-30092
AZ
225100000X
Physical Therapist
LPT-30092
AZ
2251G0304X
Geriatric Physical Therapist
LPT-30092
AZ
2251N0400X
Neurology Physical Therapist
LPT-30092
AZ
2251X0800X
Orthopedic Physical Therapist
Primary
LPT-30092
AZ
Other
Enumeration date
07/04/2018
Last updated
01/11/2022
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