Provider Demographics
NPI:1467739698
Name:LEIGHTON, ALEXANDRA ELIZABETH (LMT)
Entity Type:Individual
Prefix:
First Name:ALEXANDRA
Middle Name:ELIZABETH
Last Name:LEIGHTON
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 1:60 MELLEN ST.
Mailing Address - Street 2:APT. 4
Mailing Address - City:PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04101-5226
Mailing Address - Country:US
Mailing Address - Phone:207-615-3955
Mailing Address - Fax:
Practice Address - Street 1:60 MELLEN ST
Practice Address - Street 2:APT. 4
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04101-5226
Practice Address - Country:US
Practice Address - Phone:207-615-3955
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-16
Last Update Date:2011-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEMT 4662225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist