Provider Demographics
NPI:1023450491
Name:THOMPSON, LEILA BERYL (NMT)
Entity type:Individual
Prefix:
First Name:LEILA
Middle Name:BERYL
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:NMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1734 NAPA ST
Mailing Address - Street 2:
Mailing Address - City:VALLEJO
Mailing Address - State:CA
Mailing Address - Zip Code:94590-4463
Mailing Address - Country:US
Mailing Address - Phone:805-403-6672
Mailing Address - Fax:
Practice Address - Street 1:1734 NAPA ST
Practice Address - Street 2:
Practice Address - City:VALLEJO
Practice Address - State:CA
Practice Address - Zip Code:94590-4463
Practice Address - Country:US
Practice Address - Phone:805-403-6672
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-25
Last Update Date:2013-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA15541225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist