Provider Demographics
NPI:1699393082
Name:LEYH, LAURA LYNN (LMT)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:LYNN
Last Name:LEYH
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 1:1907 AMERICAN DR STE B3
Mailing Address - Street 2:
Mailing Address - City:NEENAH
Mailing Address - State:WI
Mailing Address - Zip Code:54956-1236
Mailing Address - Country:US
Mailing Address - Phone:920-851-9446
Mailing Address - Fax:
Practice Address - Street 1:1907 AMERICAN DR STE B3
Practice Address - Street 2:
Practice Address - City:NEENAH
Practice Address - State:WI
Practice Address - Zip Code:54956-1236
Practice Address - Country:US
Practice Address - Phone:920-851-9446
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-11
Last Update Date:2020-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI15118225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist