Kellie Ann Leavitt, PTA

Primary specialty

Physical Therapy AssistantTaxonomy code 225200000X

License

PTA-014015 Issued in AZ

Practice address

21001 N Tatum Blvd Ste 78-1640
Phoenix, AZ 85050-5244

Phone

(877) 222-5348

NPI assigned

Oct 17, 2021

Last updated

Oct 17, 2021By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Leavitt Ann Sprague Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1634428800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1634428800000",
    "number": "1417610437",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4930 W TONTO RD",
            "city": "GLENDALE",
            "state": "AZ",
            "postal_code": "853089222",
            "telephone_number": "208-241-1804"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "21001 N TATUM BLVD STE 78-1640",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850505244",
            "telephone_number": "877-222-5348"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LEAVITT",
        "first_name": "KELLIE",
        "middle_name": "ANN",
        "credential": "PTA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-10-17",
        "last_updated": "2021-10-17",
        "certification_date": "2021-10-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225200000X",
            "taxonomy_group": "",
            "desc": "Physical Therapy Assistant",
            "state": "AZ",
            "license": "PTA-014015",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ARIZONA STATE BOARD OF PHYSICAL THERAPY",
            "identifier": "PTA-014015",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "LEAVITT",
            "last_name": "SPRAGUE",
            "middle_name": "ANN",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Katherine Hannah Leary, PA-C
• Alexandra Leath
• Jarrett Michael Leathem, D.O.
• Janet Leathers, DO
• Mychal Leaupepe
• Logan Price Leavitt, DO
• Zachary Grant Lebaron, MD
• Blair Renee Lebeck
• Sylvie M.H. Lebel, M.D.
• Christian John Leber, MD

• Physical Therapy Assistant in Phoenix, AZ
• Providers in Phoenix, AZ by specialty
• Physical Therapy Assistant in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 17, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.