1134323215 NPI number — GRETCHEN A LEACHMAN DPT

Table of content: MRS. SHARON K. BAYUS M.A., LPC (NPI 1487820288)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1134323215 NPI number — GRETCHEN A LEACHMAN DPT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LEACHMAN
Provider First Name:
GRETCHEN
Provider Middle Name:
A
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
DPT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
COLWILL
Provider Other First Name:
GRETCHEN
Provider Other Middle Name:
L
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
DPT
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1134323215
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/03/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4155 MOORPARK AVE.
Provider Second Line Business Mailing Address:
SUITE 20
Provider Business Mailing Address City Name:
SAN JOSE
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
95117-1597
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
408-615-1516
Provider Business Mailing Address Fax Number:
866-754-1516

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4155 MOORPARK AVE.
Provider Second Line Business Practice Location Address:
SUTIE 20
Provider Business Practice Location Address City Name:
SAN JOSE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95117-1597
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
408-615-1516
Provider Business Practice Location Address Fax Number:
866-754-1516
Provider Enumeration Date:
06/13/2007

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:  26728 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2251G0304X , with the licence number: PT26728 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2251N0400X , with the licence number: PT26728 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2251S0007X , with the licence number: PT26728 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2251X0800X , with the licence number: 26728 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 225100000X , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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