Basic Information
| Provider Information | |||||||||
| NPI: | 1194207373 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LEECH | ||||||||
| FirstName: | TIMOTHY | ||||||||
| MiddleName: | |||||||||
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| Credential: | RD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3701 CORPORATE PKWY STE 130 | ||||||||
| Address2: | |||||||||
| City: | CENTER VALLEY | ||||||||
| State: | PA | ||||||||
| PostalCode: | 180348230 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4845267300 | ||||||||
| FaxNumber: | 6107913107 | ||||||||
| Practice Location | |||||||||
| Address1: | 3701 CORPORATE PKWY STE 130 | ||||||||
| Address2: | |||||||||
| City: | CENTER VALLEY | ||||||||
| State: | PA | ||||||||
| PostalCode: | 180348230 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4845267300 | ||||||||
| FaxNumber: | 6107913107 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/04/2018 | ||||||||
| LastUpdateDate: | 09/04/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 133V00000X | DN006518 | PA | Y | Dietary & Nutritional Service Providers | Dietitian, Registered |
No ID Information.