Provider Demographics
NPI:1336796671
Name:LEBLANC, CRETIA LYNNE (LMT, MMT)
Entity Type:Individual
Prefix:
First Name:CRETIA
Middle Name:LYNNE
Last Name:LEBLANC
Suffix:
Gender:F
Credentials:LMT, MMT
Other - Prefix:
Other - First Name:CRETIA
Other - Middle Name:LYNNE
Other - Last Name:WATKINS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMT, MMT
Mailing Address - Street 1:36 SANDHAMMOCK LAKE RD
Mailing Address - Street 2:
Mailing Address - City:TIFTON
Mailing Address - State:GA
Mailing Address - Zip Code:31793-6847
Mailing Address - Country:US
Mailing Address - Phone:229-821-1704
Mailing Address - Fax:
Practice Address - Street 1:16 LIBRARY LN
Practice Address - Street 2:
Practice Address - City:TIFTON
Practice Address - State:GA
Practice Address - Zip Code:31794-4415
Practice Address - Country:US
Practice Address - Phone:229-821-1704
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-21
Last Update Date:2019-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAMT010686225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist