Provider Demographics
NPI:1902119928
Name:MAIER, LEAH G (LMT)
Entity Type:Individual
Prefix:MRS
First Name:LEAH
Middle Name:G
Last Name:MAIER
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 1:187 NE EDISON ST
Mailing Address - Street 2:
Mailing Address - City:HILLSBORO
Mailing Address - State:OR
Mailing Address - Zip Code:97124-3051
Mailing Address - Country:US
Mailing Address - Phone:503-840-0945
Mailing Address - Fax:503-372-9603
Practice Address - Street 1:187 NE EDISON ST
Practice Address - Street 2:
Practice Address - City:HILLSBORO
Practice Address - State:OR
Practice Address - Zip Code:97124-3051
Practice Address - Country:US
Practice Address - Phone:503-840-0945
Practice Address - Fax:503-372-9603
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-19
Last Update Date:2010-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR14906172M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172M00000XOther Service ProvidersMechanotherapist