Provider Demographics
NPI:1932884103
Name:LEENDERS, MURIEL DANITA (LMT, CLT)
Entity Type:Individual
Prefix:
First Name:MURIEL
Middle Name:DANITA
Last Name:LEENDERS
Suffix:
Gender:F
Credentials:LMT, CLT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3985 PRINCE WILLIAM PKWY STE 206
Mailing Address - Street 2:
Mailing Address - City:WOODBRIDGE
Mailing Address - State:VA
Mailing Address - Zip Code:22192-7900
Mailing Address - Country:US
Mailing Address - Phone:571-368-4084
Mailing Address - Fax:
Practice Address - Street 1:3985 PRINCE WILLIAM PKWY STE 206
Practice Address - Street 2:
Practice Address - City:WOODBRIDGE
Practice Address - State:VA
Practice Address - Zip Code:22192-7900
Practice Address - Country:US
Practice Address - Phone:571-368-4084
Practice Address - Fax:571-621-5193
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-16
Last Update Date:2024-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA19019162225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist