Provider Demographics
NPI:1245211069
Name:RAZDEBA, LEANNE (LMT)
Entity Type:Individual
Prefix:
First Name:LEANNE
Middle Name:
Last Name:RAZDEBA
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 1:28412 US HIGHWAY 19 N
Mailing Address - Street 2:SUITE 2
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33761-2518
Mailing Address - Country:US
Mailing Address - Phone:727-712-2212
Mailing Address - Fax:
Practice Address - Street 1:28412 US HIGHWAY 19 N
Practice Address - Street 2:SUITE 2
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33761-2518
Practice Address - Country:US
Practice Address - Phone:727-712-2212
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA24849225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
C9079OtherBCBS OF FLORIDA