Provider Demographics
NPI:1700053550
Name:LEACH, ELIZABETH LYNN (CMT)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:LYNN
Last Name:LEACH
Suffix:
Gender:F
Credentials:CMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 TIFFANY DR
Mailing Address - Street 2:
Mailing Address - City:REHOBOTH BEACH
Mailing Address - State:DE
Mailing Address - Zip Code:19971-9729
Mailing Address - Country:US
Mailing Address - Phone:302-265-5844
Mailing Address - Fax:
Practice Address - Street 1:34362 CARPENTER'S WAY
Practice Address - Street 2:SUITE 6
Practice Address - City:LEWES
Practice Address - State:DE
Practice Address - Zip Code:19958
Practice Address - Country:US
Practice Address - Phone:302-645-0444
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-05-12
Last Update Date:2008-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEMC0002166225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist