Provider Demographics
NPI:1790825123
Name:EARLE, LEANN MARIE (LMT, CT)
Entity Type:Individual
Prefix:MRS
First Name:LEANN
Middle Name:MARIE
Last Name:EARLE
Suffix:
Gender:F
Credentials:LMT, CT
Other - Prefix:MS
Other - First Name:LEANN
Other - Middle Name:MARIE
Other - Last Name:RICKE-VERGARA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMT, CT
Mailing Address - Street 1:60 PARNELL ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:MERRITT ISLAND
Mailing Address - State:FL
Mailing Address - Zip Code:32953-4795
Mailing Address - Country:US
Mailing Address - Phone:321-459-0333
Mailing Address - Fax:321-459-3389
Practice Address - Street 1:60 PARNELL ST
Practice Address - Street 2:SUITE A
Practice Address - City:MERRITT ISLAND
Practice Address - State:FL
Practice Address - Zip Code:32953-4795
Practice Address - Country:US
Practice Address - Phone:321-459-0333
Practice Address - Fax:321-459-3389
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMM0016822225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist