Provider Demographics
NPI:1225607294
Name:LYONS, LEAH ANNE (LMT, CMT, MLD)
Entity Type:Individual
Prefix:
First Name:LEAH
Middle Name:ANNE
Last Name:LYONS
Suffix:
Gender:F
Credentials:LMT, CMT, MLD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:928 KOLLN ST
Mailing Address - Street 2:
Mailing Address - City:PLEASANTON
Mailing Address - State:CA
Mailing Address - Zip Code:94566-5625
Mailing Address - Country:US
Mailing Address - Phone:949-813-2902
Mailing Address - Fax:
Practice Address - Street 1:928 KOLLN ST
Practice Address - Street 2:
Practice Address - City:PLEASANTON
Practice Address - State:CA
Practice Address - Zip Code:94566-5625
Practice Address - Country:US
Practice Address - Phone:949-813-2902
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-23
Last Update Date:2021-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA82700225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Multi-Specialty