Basic Information
| Provider Information | |||||||||
| NPI: | 1205237195 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LEANNA | ||||||||
| FirstName: | ERIN | ||||||||
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| Credential: | PT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1625 E MAIN ST | ||||||||
| Address2: | |||||||||
| City: | CLINTONVILLE | ||||||||
| State: | WI | ||||||||
| PostalCode: | 549298407 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7158233135 | ||||||||
| FaxNumber: | 7158231313 | ||||||||
| Practice Location | |||||||||
| Address1: | 1625 E MAIN ST | ||||||||
| Address2: | |||||||||
| City: | CLINTONVILLE | ||||||||
| State: | WI | ||||||||
| PostalCode: | 549298407 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7158233135 | ||||||||
| FaxNumber: | 7158231313 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/10/2014 | ||||||||
| LastUpdateDate: | 06/07/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 06/07/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 10004-24 | WI | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.