Provider Demographics
NPI:1669864922
Name:LEADBETTER, TABITHA (LMT)
Entity Type:Individual
Prefix:
First Name:TABITHA
Middle Name:
Last Name:LEADBETTER
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 1803
Mailing Address - Street 2:
Mailing Address - City:GRAY
Mailing Address - State:ME
Mailing Address - Zip Code:04039-1803
Mailing Address - Country:US
Mailing Address - Phone:207-576-9364
Mailing Address - Fax:
Practice Address - Street 1:6 MAIN STREET, STE 6
Practice Address - Street 2:
Practice Address - City:GRAY
Practice Address - State:ME
Practice Address - Zip Code:04039
Practice Address - Country:US
Practice Address - Phone:207-576-9364
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-02-24
Last Update Date:2015-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEMT5191225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist