Provider Demographics
NPI:1013148840
Name:COLLINS, LEAH (DOM, LMT)
Entity Type:Individual
Prefix:DR
First Name:LEAH
Middle Name:
Last Name:COLLINS
Suffix:
Gender:F
Credentials:DOM, LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1348 PACHECO ST
Mailing Address - Street 2:SUITE 206
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87505-4222
Mailing Address - Country:US
Mailing Address - Phone:505-988-2449
Mailing Address - Fax:505-986-6005
Practice Address - Street 1:1348 PACHECO ST
Practice Address - Street 2:SUITE 206
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87505-4222
Practice Address - Country:US
Practice Address - Phone:505-988-2449
Practice Address - Fax:505-986-6005
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-28
Last Update Date:2013-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM999171100000X
NM3765225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Multi-Specialty
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Multi-Specialty