Provider Demographics
NPI:1801485784
Name:BENNETT, LEAH MARIE (LMT)
Entity type:Individual
Prefix:
First Name:LEAH
Middle Name:MARIE
Last Name:BENNETT
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 1:227 E GROVE ST
Mailing Address - Street 2:
Mailing Address - City:ONEIDA
Mailing Address - State:NY
Mailing Address - Zip Code:13421-2405
Mailing Address - Country:US
Mailing Address - Phone:315-991-9162
Mailing Address - Fax:
Practice Address - Street 1:2605 BREWERTON RD
Practice Address - Street 2:
Practice Address - City:MATTYDALE
Practice Address - State:NY
Practice Address - Zip Code:13211-1147
Practice Address - Country:US
Practice Address - Phone:315-455-9355
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-14
Last Update Date:2021-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY032267225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist