Provider Demographics
NPI:1912181652
Name:LEON, LISA CHERIE (LMT)
Entity Type:Individual
Prefix:MRS
First Name:LISA
Middle Name:CHERIE
Last Name:LEON
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 1:5757 NE 9TH ST
Mailing Address - Street 2:
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50313-1563
Mailing Address - Country:US
Mailing Address - Phone:515-707-5649
Mailing Address - Fax:
Practice Address - Street 1:116 SE LORENZ DR
Practice Address - Street 2:
Practice Address - City:ANKENY
Practice Address - State:IA
Practice Address - Zip Code:50021-9228
Practice Address - Country:US
Practice Address - Phone:515-963-7676
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-17
Last Update Date:2007-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA00583225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist