Individual
BRENDA KAYE LEAVELLE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PT
Contact information
Practice address
530 E 2ND ST, DULUTH, MN 55805-1913
(218) 786-5360
Mailing address
530 E 2ND ST, DULUTH, MN 55805-1913
(218) 786-5360
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
5262
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
40269200
—
WI
01
—
6401789
MEDICA
—
Enumeration date
07/10/2006
Last updated
07/25/2019
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