Provider Demographics
NPI:1831644491
Name:HAMPTON, LELAND WAYNE
Entity Type:Individual
Prefix:MR
First Name:LELAND
Middle Name:WAYNE
Last Name:HAMPTON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15001 35TH AVE W
Mailing Address - Street 2:APARTMENT 3-307
Mailing Address - City:LYNNWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98087-2343
Mailing Address - Country:US
Mailing Address - Phone:702-204-6797
Mailing Address - Fax:
Practice Address - Street 1:15001 35TH AVE W
Practice Address - Street 2:APARTMENT 3-307
Practice Address - City:LYNNWOOD
Practice Address - State:WA
Practice Address - Zip Code:98087-2343
Practice Address - Country:US
Practice Address - Phone:702-204-6797
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-23
Last Update Date:2016-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60689830225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist