Provider Demographics
NPI:1578864583
Name:REISER, LEANNE P (PTA)
Entity type:Individual
Prefix:MRS
First Name:LEANNE
Middle Name:P
Last Name:REISER
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7311 QUARTZ HILL DR
Mailing Address - Street 2:
Mailing Address - City:WEST JORDAN
Mailing Address - State:UT
Mailing Address - Zip Code:84081-4148
Mailing Address - Country:US
Mailing Address - Phone:801-282-9926
Mailing Address - Fax:
Practice Address - Street 1:7311 QUARTZ HILL DR
Practice Address - Street 2:
Practice Address - City:WEST JORDAN
Practice Address - State:UT
Practice Address - Zip Code:84081-4148
Practice Address - Country:US
Practice Address - Phone:801-282-9926
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-11-07
Last Update Date:2010-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT289640-2402225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant