Provider Demographics
NPI:1538312392
Name:LEON, PATRICIA (LMT)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:
Last Name:LEON
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:PO BOX 49583
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34230-6583
Mailing Address - Country:US
Mailing Address - Phone:941-321-6917
Mailing Address - Fax:941-366-6075
Practice Address - Street 1:810 CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34236-4021
Practice Address - Country:US
Practice Address - Phone:941-321-6917
Practice Address - Fax:941-366-6075
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-24
Last Update Date:2008-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA0027504225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLC2653OtherBLUE CROSS