Provider Demographics
NPI:1679260400
Name:LEASURE, SHELBEY ELIZABETH (LMT)
Entity Type:Individual
Prefix:
First Name:SHELBEY
Middle Name:ELIZABETH
Last Name:LEASURE
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 1:3503 LONE HICKORY DR
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:MO
Mailing Address - Zip Code:63379-5330
Mailing Address - Country:US
Mailing Address - Phone:219-877-4475
Mailing Address - Fax:
Practice Address - Street 1:3503 LONE HICKORY DR
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:MO
Practice Address - Zip Code:63379-5330
Practice Address - Country:US
Practice Address - Phone:219-877-4475
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-21
Last Update Date:2023-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2023008371225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist