Provider Demographics
NPI:1619636438
Name:FLOYD, LEAH R (LCAT, ATR-BC)
Entity Type:Individual
Prefix:MS
First Name:LEAH
Middle Name:R
Last Name:FLOYD
Suffix:
Gender:F
Credentials:LCAT, ATR-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5620 GULFPORT BLVD S APT 5
Mailing Address - Street 2:
Mailing Address - City:GULFPORT
Mailing Address - State:FL
Mailing Address - Zip Code:33707-4800
Mailing Address - Country:US
Mailing Address - Phone:912-294-6993
Mailing Address - Fax:
Practice Address - Street 1:5620 GULFPORT BLVD S APT 5
Practice Address - Street 2:
Practice Address - City:GULFPORT
Practice Address - State:FL
Practice Address - Zip Code:33707-4800
Practice Address - Country:US
Practice Address - Phone:912-294-6993
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-08
Last Update Date:2021-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY001961221700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes221700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersArt Therapist