Provider Demographics
NPI:1609577071
Name:LEY, JOHN (LMT)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:
Last Name:LEY
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3898 EVERWOOD LN
Mailing Address - Street 2:
Mailing Address - City:ADDISON
Mailing Address - State:TX
Mailing Address - Zip Code:75001-4328
Mailing Address - Country:US
Mailing Address - Phone:214-563-0383
Mailing Address - Fax:
Practice Address - Street 1:3898 EVERWOOD LN
Practice Address - Street 2:
Practice Address - City:ADDISON
Practice Address - State:TX
Practice Address - Zip Code:75001-4328
Practice Address - Country:US
Practice Address - Phone:214-563-0383
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-13
Last Update Date:2023-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXMT137717225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist