Provider Demographics
NPI:1184741621
Name:SPRING, LESLIE (LMP)
Entity type:Individual
Prefix:
First Name:LESLIE
Middle Name:
Last Name:SPRING
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 378
Mailing Address - Street 2:
Mailing Address - City:VALLEYFORD
Mailing Address - State:WA
Mailing Address - Zip Code:99036-0378
Mailing Address - Country:US
Mailing Address - Phone:509-924-9127
Mailing Address - Fax:509-924-9127
Practice Address - Street 1:12310 E. CONNOR
Practice Address - Street 2:
Practice Address - City:VALLEYFORD
Practice Address - State:WA
Practice Address - Zip Code:99036
Practice Address - Country:US
Practice Address - Phone:509-924-9127
Practice Address - Fax:509-924-9127
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-22
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA 14714225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAMA 14714Medicare UPIN