1538500277 NPI number — LEAH GASSER PT,

Table of content: (NPI 1285626713)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1538500277 NPI number — LEAH GASSER PT,

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GASSER
Provider First Name:
LEAH
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PT,
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
GASSER
Provider Other First Name:
LEAH
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
PT
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1538500277
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/01/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
145 SMOKERISE DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WADSWORTH
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
44281-8702
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
330-335-4200
Provider Business Mailing Address Fax Number:
330-335-7131

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1500 CANTON RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
AKRON
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
44312-4089
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
330-784-1271
Provider Business Practice Location Address Fax Number:
330-733-2975
Provider Enumeration Date:
07/10/2013

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  13892 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)