Provider Demographics
NPI:1558486407
Name:CARR, LEIAH JEANINE (LMT)
Entity Type:Individual
Prefix:MRS
First Name:LEIAH
Middle Name:JEANINE
Last Name:CARR
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 1:6325 ARLINGTON RD
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32211-5423
Mailing Address - Country:US
Mailing Address - Phone:904-477-2277
Mailing Address - Fax:904-744-8038
Practice Address - Street 1:6325 ARLINGTON RD
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32211-5423
Practice Address - Country:US
Practice Address - Phone:904-477-2277
Practice Address - Fax:904-744-8038
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-20
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA 29890225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist