Provider Demographics
NPI:1457510133
Name:LEYDA, LYNN D (NCTMB)
Entity type:Individual
Prefix:MISS
First Name:LYNN
Middle Name:D
Last Name:LEYDA
Suffix:
Gender:F
Credentials:NCTMB
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:225 E GRANGER AVE
Mailing Address - Street 2:SUITE 2
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95350-4346
Mailing Address - Country:US
Mailing Address - Phone:209-529-8191
Mailing Address - Fax:
Practice Address - Street 1:225 E GRANGER AVE
Practice Address - Street 2:SUITE 2
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95350-4346
Practice Address - Country:US
Practice Address - Phone:209-529-8191
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-06
Last Update Date:2008-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
387688-00OtherNATIONAL CERTIFICATION BOARD FOR THERAPEUTIC MASSAGE AND BODYWORK