Provider Demographics
NPI:1770892788
Name:LEEPER, JACQUELYN T (LMT)
Entity type:Individual
Prefix:
First Name:JACQUELYN
Middle Name:T
Last Name:LEEPER
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 1:212 SE 7TH ST
Mailing Address - Street 2:NUMBER 2
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32601-5802
Mailing Address - Country:US
Mailing Address - Phone:352-262-2170
Mailing Address - Fax:
Practice Address - Street 1:212 SE 7TH ST
Practice Address - Street 2:NUMBER 2
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32601-5802
Practice Address - Country:US
Practice Address - Phone:352-262-2170
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-26
Last Update Date:2010-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA50197225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist