Provider Demographics
NPI:1699218164
Name:LEON, JAZMIN ANEL (LMT)
Entity Type:Individual
Prefix:
First Name:JAZMIN
Middle Name:ANEL
Last Name:LEON
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 1:182 CUMBERLAND ST APT 68
Mailing Address - Street 2:
Mailing Address - City:WOONSOCKET
Mailing Address - State:RI
Mailing Address - Zip Code:02895-4722
Mailing Address - Country:US
Mailing Address - Phone:401-999-5577
Mailing Address - Fax:
Practice Address - Street 1:182 CUMBERLAND ST APT 68
Practice Address - Street 2:
Practice Address - City:WOONSOCKET
Practice Address - State:RI
Practice Address - Zip Code:02895-4722
Practice Address - Country:US
Practice Address - Phone:401-999-5577
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-30
Last Update Date:2016-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA14162225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist