Provider Demographics
NPI:1982777025
Name:LEYEN, CARLA ANN (MSPT, MOMT)
Entity type:Individual
Prefix:MRS
First Name:CARLA
Middle Name:ANN
Last Name:LEYEN
Suffix:
Gender:F
Credentials:MSPT, MOMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:802 PARK ST
Mailing Address - Street 2:
Mailing Address - City:REINBECK
Mailing Address - State:IA
Mailing Address - Zip Code:50669-1224
Mailing Address - Country:US
Mailing Address - Phone:319-345-2963
Mailing Address - Fax:319-334-6166
Practice Address - Street 1:100 LINDSEY LN STE A
Practice Address - Street 2:
Practice Address - City:SAINT MARYS
Practice Address - State:GA
Practice Address - Zip Code:31558-1727
Practice Address - Country:US
Practice Address - Phone:912-729-1333
Practice Address - Fax:912-729-5259
Is Sole Proprietor?:No
Enumeration Date:2006-11-16
Last Update Date:2024-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA02243225100000X
GACPO37378T225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist