Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225700000X | Massage Therapist | 162341 | CO |
NPI | 1003342452 |
---|---|
Provider Name | Ms. Barbara Dee Leach |
First Address | Grand Junction, CO 81501-2676 |
Second Address | Grand Junction, CO 81501-2667 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 04/05/2017 |
Last Update Date | 04/05/2017 |