Provider Demographics
NPI:1508551763
Name:MUELLER, LESLIE JACKSON (LMT)
Entity Type:Individual
Prefix:
First Name:LESLIE
Middle Name:JACKSON
Last Name:MUELLER
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 1:10473 GEORGETOWN RD
Mailing Address - Street 2:
Mailing Address - City:MECHANICSVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:23116-4847
Mailing Address - Country:US
Mailing Address - Phone:615-651-2140
Mailing Address - Fax:
Practice Address - Street 1:10473 GEORGETOWN RD
Practice Address - Street 2:
Practice Address - City:MECHANICSVILLE
Practice Address - State:VA
Practice Address - Zip Code:23116-4847
Practice Address - Country:US
Practice Address - Phone:615-651-2140
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-05
Last Update Date:2023-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist