Provider Demographics
NPI:1083220917
Name:AVRAM, LEANNA RENE
Entity Type:Individual
Prefix:
First Name:LEANNA
Middle Name:RENE
Last Name:AVRAM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:LEANNA
Other - Middle Name:RENE
Other - Last Name:MARGHEIM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1775 YOSEMITE ST
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80220-2249
Mailing Address - Country:US
Mailing Address - Phone:720-879-1644
Mailing Address - Fax:
Practice Address - Street 1:1775 YOSEMITE ST
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80220-2249
Practice Address - Country:US
Practice Address - Phone:720-879-1644
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-16
Last Update Date:2020-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COMT.0022684225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist