Provider Demographics
NPI:1780028159
Name:KNOWLES, LEAH MICHELLE (LMT)
Entity Type:Individual
Prefix:
First Name:LEAH
Middle Name:MICHELLE
Last Name:KNOWLES
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 1:833 MAIN STREET
Mailing Address - Street 2:ROUTE 28
Mailing Address - City:SOUTH YARMOUTH
Mailing Address - State:MA
Mailing Address - Zip Code:02664-5254
Mailing Address - Country:US
Mailing Address - Phone:508-394-1353
Mailing Address - Fax:508-398-2866
Practice Address - Street 1:833 MAIN STREET
Practice Address - Street 2:ROUTE 28
Practice Address - City:SOUTH YARMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02664-5254
Practice Address - Country:US
Practice Address - Phone:508-394-1353
Practice Address - Fax:508-398-2866
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-29
Last Update Date:2013-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA10043225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist