Provider Demographics
NPI:1609051911
Name:LEAVITT, SHERYL J (LMP)
Entity type:Individual
Prefix:MS
First Name:SHERYL
Middle Name:J
Last Name:LEAVITT
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:12430 N THORP HWY
Mailing Address - Street 2:
Mailing Address - City:THORP
Mailing Address - State:WA
Mailing Address - Zip Code:98946-9587
Mailing Address - Country:US
Mailing Address - Phone:509-929-3540
Mailing Address - Fax:509-962-9774
Practice Address - Street 1:104 W 5TH AVE
Practice Address - Street 2:
Practice Address - City:ELLENSBURG
Practice Address - State:WA
Practice Address - Zip Code:98926-3102
Practice Address - Country:US
Practice Address - Phone:509-929-3540
Practice Address - Fax:509-962-9774
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-04
Last Update Date:2008-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00009438225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist