Basic Information
| Provider Information | |||||||||
| NPI: | 1912488925 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | LEIGHTY | ||||||||
| FirstName: | NOELLE | ||||||||
| MiddleName: | ELIZABETH | ||||||||
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| Credential: | PT, DPT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 246 TOWNSHIP ROAD 1214 | ||||||||
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| City: | IRONTON | ||||||||
| State: | OH | ||||||||
| PostalCode: | 456388809 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7406463410 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2125 ROYCE ST | ||||||||
| Address2: | |||||||||
| City: | PORTSMOUTH | ||||||||
| State: | OH | ||||||||
| PostalCode: | 456624714 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7403546635 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/27/2018 | ||||||||
| LastUpdateDate: | 08/27/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | PT017671 | OH | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.