Provider Demographics
NPI:1841434909
Name:LEIBACHER, MONICA (LMT, CST)
Entity type:Individual
Prefix:MRS
First Name:MONICA
Middle Name:
Last Name:LEIBACHER
Suffix:
Gender:F
Credentials:LMT, CST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1201 GREENE SQ
Mailing Address - Street 2:
Mailing Address - City:CELEBRATION
Mailing Address - State:FL
Mailing Address - Zip Code:34747-4057
Mailing Address - Country:US
Mailing Address - Phone:407-566-8852
Mailing Address - Fax:
Practice Address - Street 1:690 CELEBRATION AVE
Practice Address - Street 2:SUITE 250
Practice Address - City:CELEBRATION
Practice Address - State:FL
Practice Address - Zip Code:34747-4689
Practice Address - Country:US
Practice Address - Phone:407-566-8852
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-20
Last Update Date:2011-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA53274225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist