Provider Demographics
NPI:1356501811
Name:LEESTMA, REBECCA JEAN (LMP)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:JEAN
Last Name:LEESTMA
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:309 E FARWELL RD
Mailing Address - Street 2:206
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99218-8202
Mailing Address - Country:US
Mailing Address - Phone:509-465-8400
Mailing Address - Fax:509-465-8500
Practice Address - Street 1:309 E FARWELL RD
Practice Address - Street 2:206
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99218-8202
Practice Address - Country:US
Practice Address - Phone:509-465-8400
Practice Address - Fax:509-465-8500
Is Sole Proprietor?:No
Enumeration Date:2008-06-09
Last Update Date:2009-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00023572225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist