Provider Demographics
NPI:1457539256
Name:LEAH K BYRD THERAPEUTIC MASSAGE INC
Entity Type:Organization
Organization Name:LEAH K BYRD THERAPEUTIC MASSAGE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:LEAH
Authorized Official - Middle Name:KRISTIN
Authorized Official - Last Name:BYRD
Authorized Official - Suffix:
Authorized Official - Credentials:LMT
Authorized Official - Phone:727-543-9289
Mailing Address - Street 1:12800 INDIAN ROCKS RD
Mailing Address - Street 2:SUITE 6A/6B
Mailing Address - City:LARGO
Mailing Address - State:FL
Mailing Address - Zip Code:33774-2000
Mailing Address - Country:US
Mailing Address - Phone:727-543-9289
Mailing Address - Fax:
Practice Address - Street 1:12800 INDIAN ROCKS RD
Practice Address - Street 2:SUITE 6A/6B
Practice Address - City:LARGO
Practice Address - State:FL
Practice Address - Zip Code:33774-2000
Practice Address - Country:US
Practice Address - Phone:727-543-9289
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-04
Last Update Date:2008-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMM20733225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty