Individual
TINA LEACH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPTA
Contact information
Practice address
2100 E PROVINCIAL HOUSE DR, LANSING, MI 48910-4884
(517) 272-4029
(517) 272-4035
Mailing address
2100 E PROVINCIAL HOUSE DR, LANSING, MI 48910-4884
(517) 272-4029
(517) 272-4035
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
5502000559
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1538480504
—
MI
Enumeration date
11/08/2013
Last updated
11/08/2013
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