Provider Demographics
NPI:1043784945
Name:LEIB, ZHAVANYA LEIGH (LMT)
Entity Type:Individual
Prefix:MRS
First Name:ZHAVANYA
Middle Name:LEIGH
Last Name:LEIB
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:502 WAGNER CREEK RD
Mailing Address - Street 2:
Mailing Address - City:TALENT
Mailing Address - State:OR
Mailing Address - Zip Code:97540-6728
Mailing Address - Country:US
Mailing Address - Phone:541-500-7184
Mailing Address - Fax:
Practice Address - Street 1:940 ELLENDALE DR STE 102
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:OR
Practice Address - Zip Code:97504-8216
Practice Address - Country:US
Practice Address - Phone:541-210-5687
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-15
Last Update Date:2019-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR18136225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty