Provider Demographics
NPI:1184859308
Name:STULLKEN, LEONORA T (LMT)
Entity Type:Individual
Prefix:MS
First Name:LEONORA
Middle Name:T
Last Name:STULLKEN
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:PO BOX 430154
Mailing Address - Street 2:
Mailing Address - City:BIG PINE KEY
Mailing Address - State:FL
Mailing Address - Zip Code:33043-0154
Mailing Address - Country:US
Mailing Address - Phone:305-872-8915
Mailing Address - Fax:305-872-8915
Practice Address - Street 1:30570 17TH ST
Practice Address - Street 2:
Practice Address - City:BIG PINE KEY
Practice Address - State:FL
Practice Address - Zip Code:33043
Practice Address - Country:US
Practice Address - Phone:305-872-8915
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-18
Last Update Date:2009-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA9156225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist