Provider Demographics
NPI:1447448238
Name:IRVIN, LEAH S (PT, MS, CLT-LANA)
Entity type:Individual
Prefix:
First Name:LEAH
Middle Name:S
Last Name:IRVIN
Suffix:
Gender:F
Credentials:PT, MS, CLT-LANA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11890 FEATHERWOOD DR
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63146-4700
Mailing Address - Country:US
Mailing Address - Phone:314-402-5904
Mailing Address - Fax:
Practice Address - Street 1:2001 S HANLEY RD
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63144-1518
Practice Address - Country:US
Practice Address - Phone:314-821-8304
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-10-05
Last Update Date:2007-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO118019225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist