Provider Demographics
NPI:1770294910
Name:SCHIMKE, LEANNE (LMT)
Entity type:Individual
Prefix:
First Name:LEANNE
Middle Name:
Last Name:SCHIMKE
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:LEANNE
Other - Middle Name:
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMT
Mailing Address - Street 1:2682 SPRING CT
Mailing Address - Street 2:
Mailing Address - City:ZEELAND
Mailing Address - State:MI
Mailing Address - Zip Code:49464-9113
Mailing Address - Country:US
Mailing Address - Phone:702-758-3154
Mailing Address - Fax:
Practice Address - Street 1:509 MICHIGAN AVE
Practice Address - Street 2:
Practice Address - City:HOLLAND
Practice Address - State:MI
Practice Address - Zip Code:49423-4750
Practice Address - Country:US
Practice Address - Phone:702-758-3154
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-12-08
Last Update Date:2022-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI7501010972225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist