Provider Demographics
NPI:1770845950
Name:SHIRLEY, LEAH YVONNE (CMT)
Entity Type:Individual
Prefix:MRS
First Name:LEAH
Middle Name:YVONNE
Last Name:SHIRLEY
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 1:9242 CREEK WAY
Mailing Address - Street 2:
Mailing Address - City:SAVAGE
Mailing Address - State:MN
Mailing Address - Zip Code:55378-1194
Mailing Address - Country:US
Mailing Address - Phone:952-949-0676
Mailing Address - Fax:
Practice Address - Street 1:11800 SINGLETREE LN STE 205
Practice Address - Street 2:
Practice Address - City:EDEN PRAIRIE
Practice Address - State:MN
Practice Address - Zip Code:55344-5397
Practice Address - Country:US
Practice Address - Phone:952-949-0676
Practice Address - Fax:952-949-0868
Is Sole Proprietor?:No
Enumeration Date:2012-06-13
Last Update Date:2012-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172M00000XOther Service ProvidersMechanotherapist