Provider Demographics
NPI:1730733890
Name:O'CONNELL, LEANDI (DPT)
Entity type:Individual
Prefix:
First Name:LEANDI
Middle Name:
Last Name:O'CONNELL
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:LEANDI
Other - Middle Name:
Other - Last Name:VENTER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1650 LYNDON FARM CT STE 300
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40223-5005
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3401 VILLAGE DR STE 101
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28304-4517
Practice Address - Country:US
Practice Address - Phone:910-483-9300
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-27
Last Update Date:2024-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIPT-4862225100000X
VA2305215520225100000X
NCCP024580T225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI53213OtherUNIVERSITY HEALTH ALLIANCE