Provider Demographics
NPI:1932473444
Name:DAWSON LEACH, CHERYL E (LMT)
Entity Type:Individual
Prefix:
First Name:CHERYL
Middle Name:E
Last Name:DAWSON LEACH
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 1:528 SWAN HILL DR
Mailing Address - Street 2:MASSAGE MAGIC
Mailing Address - City:BIGFORK
Mailing Address - State:MT
Mailing Address - Zip Code:59911-6312
Mailing Address - Country:US
Mailing Address - Phone:406-837-1277
Mailing Address - Fax:
Practice Address - Street 1:528 SWAN HILL DR
Practice Address - Street 2:MASSAGE MAGIC
Practice Address - City:BIGFORK
Practice Address - State:MT
Practice Address - Zip Code:59911-6312
Practice Address - Country:US
Practice Address - Phone:406-837-1277
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-01
Last Update Date:2012-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT220225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist