Provider Demographics
NPI:1366715021
Name:LEBER, LEISA LYNN (LMT)
Entity type:Individual
Prefix:MS
First Name:LEISA
Middle Name:LYNN
Last Name:LEBER
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28 S POPLAR ST
Mailing Address - Street 2:S-101
Mailing Address - City:ELIZABETHTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:17022-2158
Mailing Address - Country:US
Mailing Address - Phone:717-367-2718
Mailing Address - Fax:
Practice Address - Street 1:28 S POPLAR ST
Practice Address - Street 2:S-101
Practice Address - City:ELIZABETHTOWN
Practice Address - State:PA
Practice Address - Zip Code:17022-2158
Practice Address - Country:US
Practice Address - Phone:717-367-2718
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-10
Last Update Date:2012-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMSG002784174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist