Provider Demographics
NPI:1336522382
Name:LEON, DEYANIRA (LMT)
Entity Type:Individual
Prefix:
First Name:DEYANIRA
Middle Name:
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 1:5201 SW 98TH AVENUE RD
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33165-7248
Mailing Address - Country:US
Mailing Address - Phone:786-539-6676
Mailing Address - Fax:
Practice Address - Street 1:14750 SW 26TH ST STE 213
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33185-5937
Practice Address - Country:US
Practice Address - Phone:786-476-7314
Practice Address - Fax:786-476-7315
Is Sole Proprietor?:No
Enumeration Date:2015-07-08
Last Update Date:2015-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA 62525225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist