Provider Demographics
NPI:1144718750
Name:TAPTICH, LEEANN
Entity type:Individual
Prefix:
First Name:LEEANN
Middle Name:
Last Name:TAPTICH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:LEEANN
Other - Middle Name:
Other - Last Name:PELLOW
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT, DPT
Mailing Address - Street 1:537 MIDLAND BLVD
Mailing Address - Street 2:
Mailing Address - City:ROYAL OAK
Mailing Address - State:MI
Mailing Address - Zip Code:48073-2806
Mailing Address - Country:US
Mailing Address - Phone:904-814-7495
Mailing Address - Fax:
Practice Address - Street 1:15595 15 MILE RD
Practice Address - Street 2:
Practice Address - City:CLINTON TOWNSHIP
Practice Address - State:MI
Practice Address - Zip Code:48035-2185
Practice Address - Country:US
Practice Address - Phone:586-285-3884
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-30
Last Update Date:2021-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI550101367225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist