Provider Demographics
NPI:1346949856
Name:BURNS, LEIGHA RAE
Entity Type:Individual
Prefix:
First Name:LEIGHA
Middle Name:RAE
Last Name:BURNS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:638 CASTINE WAY
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28412-2763
Mailing Address - Country:US
Mailing Address - Phone:651-212-8577
Mailing Address - Fax:
Practice Address - Street 1:5541 CAROLINA BEACH RD STE 130
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28412-3606
Practice Address - Country:US
Practice Address - Phone:910-794-5252
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-23
Last Update Date:2023-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC17393225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist