Individual ProviderMiranda N LeachPhysical Therapy AssistantRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPractice Address2547 Trojan Dr, Green Bay, WI 54304-1436(573) 718-9947PECOS EnrollmentBased on the most recent information from CMS, provider Miranda N Leach does not have current enrollment records in PECOS.Part BMedicare Part BNot EnrolledHHAHome Health AgencyNot EnrolledDMEDurable Medical EquipmentNot EnrolledPMDPower Mobility DeviceNot EnrolledCMS last updated its PECOS records yesterday at 12:57 PM.Profile DetailsProvider ID1770185514Provider TypeIndividualFull NameLeach, Miranda NCredentialPTAGenderFemaleSole ProprietorYesEnumeration Date11/16/2020Last Updated11/16/2020Contact InformationPractice LocationPractice Address2547 Trojan Dr, Green Bay, WI 54304-1436Phone(573) 718-9947FaxUnlisted FaxMailing LocationMailing Address2547 Trojan Dr, Green Bay, WI 54304-1436Phone(573) 718-9947FaxUnlisted FaxProvider TaxonomiesCodeDescriptionLicenseCode225200000XPrimaryDescriptionPhysical Therapy AssistantRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersLicense3105-19Wisconsin