Provider Demographics
NPI:1154099356
Name:LEACH, JASMINE SYMONE (ATC)
Entity Type:Individual
Prefix:
First Name:JASMINE
Middle Name:SYMONE
Last Name:LEACH
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16367 ENCLAVE VILLAGE DR
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33647-5105
Mailing Address - Country:US
Mailing Address - Phone:478-320-7022
Mailing Address - Fax:
Practice Address - Street 1:16367 ENCLAVE VILLAGE DR
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33647-5105
Practice Address - Country:US
Practice Address - Phone:478-320-7022
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-01
Last Update Date:2022-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program