| NPI | 1689119117 |
|---|---|
| Former Name | LISA MCKELL LEAVITT |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: UT 10190968-2401) |
| Additional Taxonomies | 2251X0800X Physical Therapist, Orthopedic (Licence: UT 10190968-8016) |
| Enumeration Date | 2016-12-19 |
| Last Update Date | 2025-02-27 |