Provider Demographics
NPI:1780448225
Name:LEUPOLD, EMILY ELIZABETH (LMT)
Entity type:Individual
Prefix:
First Name:EMILY
Middle Name:ELIZABETH
Last Name:LEUPOLD
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 1:136 PATTON ST
Mailing Address - Street 2:
Mailing Address - City:COOKEVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38506-5233
Mailing Address - Country:US
Mailing Address - Phone:360-628-2339
Mailing Address - Fax:
Practice Address - Street 1:103 W MAIN ST
Practice Address - Street 2:
Practice Address - City:COOKEVILLE
Practice Address - State:TN
Practice Address - Zip Code:38506-2309
Practice Address - Country:US
Practice Address - Phone:931-537-2535
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-06
Last Update Date:2024-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC19702225700000X
TN14533225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist