Provider Demographics
NPI:1376845982
Name:DOUGLAS, LEIGH ANNE (LMT)
Entity Type:Individual
Prefix:MISS
First Name:LEIGH ANNE
Middle Name:
Last Name:DOUGLAS
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 1:4750 SW 91ST DR
Mailing Address - Street 2:STE. A
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32608-8140
Mailing Address - Country:US
Mailing Address - Phone:352-367-9602
Mailing Address - Fax:
Practice Address - Street 1:4750 SW 91ST DR
Practice Address - Street 2:SUITE A
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32608-8140
Practice Address - Country:US
Practice Address - Phone:352-367-9602
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-02
Last Update Date:2010-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA60419225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist