Provider Demographics
NPI:1639452865
Name:LEININGER, JENNA L (LMT, DIPL ABT, CP A)
Entity Type:Individual
Prefix:MRS
First Name:JENNA
Middle Name:L
Last Name:LEININGER
Suffix:
Gender:F
Credentials:LMT, DIPL ABT, CP A
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 2002
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NM
Mailing Address - Zip Code:87701-2002
Mailing Address - Country:US
Mailing Address - Phone:505-718-5261
Mailing Address - Fax:
Practice Address - Street 1:508 UNIVERSITY AVE
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NM
Practice Address - Zip Code:87701-4349
Practice Address - Country:US
Practice Address - Phone:505-718-5261
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-23
Last Update Date:2013-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMLMT6891225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist