Provider Demographics
NPI:1700491677
Name:LEYS, PATRICE ALICIA (LMT)
Entity Type:Individual
Prefix:
First Name:PATRICE
Middle Name:ALICIA
Last Name:LEYS
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 1:4046 N GOLDENROD RD # 183
Mailing Address - Street 2:
Mailing Address - City:WINTER PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32792-8911
Mailing Address - Country:US
Mailing Address - Phone:646-543-8172
Mailing Address - Fax:
Practice Address - Street 1:2022 NW 43RD TER APT 6
Practice Address - Street 2:
Practice Address - City:LAUDERHILL
Practice Address - State:FL
Practice Address - Zip Code:33313-4340
Practice Address - Country:US
Practice Address - Phone:646-543-8172
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-09
Last Update Date:2020-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171W00000X, 174200000X, 174H00000X, 247200000X, 261QH0100X
FLMA63574173C00000X, 225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Multi-Specialty
No171W00000XOther Service ProvidersContractor
No173C00000XOther Service ProvidersReflexologistGroup - Multi-Specialty
No174200000XOther Service ProvidersMeals
No174H00000XOther Service ProvidersHealth EducatorGroup - Multi-Specialty
No247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other
No261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service