Basic Information
| Provider Information | |||||||||
| NPI: | 1245279579 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MORGAN | ||||||||
| FirstName: | LEANNE | ||||||||
| MiddleName: | KIPP BROFEE | ||||||||
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| Credential: | DPT | ||||||||
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| OtherLastName: | BROFEE | ||||||||
| OtherFirstName: | LEANNE | ||||||||
| OtherMiddleName: | KIPP | ||||||||
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| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 7 DOCK HILL RD | ||||||||
| Address2: | |||||||||
| City: | MIDDLEBURG | ||||||||
| State: | PA | ||||||||
| PostalCode: | 178428910 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5708372123 | ||||||||
| FaxNumber: | 5708372185 | ||||||||
| Practice Location | |||||||||
| Address1: | 44 RED HILL CT | ||||||||
| Address2: | |||||||||
| City: | NEWPORT | ||||||||
| State: | PA | ||||||||
| PostalCode: | 170748706 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7175673200 | ||||||||
| FaxNumber: | 7175673254 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/05/2006 | ||||||||
| LastUpdateDate: | 03/12/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | DAPT001414 | PA | N | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | 225100000X | PT017957 | PA | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
ID Information
| ID | Type | State | Issuer | Description | 1015417970002 | 05 | PA | MEDICAID |