Provider Demographics
NPI:1235445768
Name:LEUTHNER, MARY TERESA (NTS)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:TERESA
Last Name:LEUTHNER
Suffix:
Gender:F
Credentials:NTS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:827 BAYSIDE RD
Mailing Address - Street 2:
Mailing Address - City:ARCATA
Mailing Address - State:CA
Mailing Address - Zip Code:95521-6403
Mailing Address - Country:US
Mailing Address - Phone:707-822-4300
Mailing Address - Fax:
Practice Address - Street 1:827 BAYSIDE RD
Practice Address - Street 2:
Practice Address - City:ARCATA
Practice Address - State:CA
Practice Address - Zip Code:95521-6403
Practice Address - Country:US
Practice Address - Phone:707-822-4300
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-22
Last Update Date:2010-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist