Individual
MIRANDA N LEACH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PTA
Contact information
Practice address
2547 TROJAN DR, GREEN BAY, WI 54304-1436
(573) 718-9947
Mailing address
2547 TROJAN DR, GREEN BAY, WI 54304-1436
(573) 718-9947
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
3105-19
WI
Other
Enumeration date
11/16/2020
Last updated
11/16/2020
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