Provider Demographics
NPI:1225336217
Name:DIAZ, LEIDY (LMT)
Entity Type:Individual
Prefix:
First Name:LEIDY
Middle Name:
Last Name:DIAZ
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 1:5271 NW 5TH ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33126-5033
Mailing Address - Country:US
Mailing Address - Phone:786-470-7209
Mailing Address - Fax:
Practice Address - Street 1:5271 NW 5TH ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33126-5033
Practice Address - Country:US
Practice Address - Phone:786-470-7209
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-01
Last Update Date:2011-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA62062225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist