Provider Demographics
NPI:1871963751
Name:LEEMAN, TRACY LYNN (LMT)
Entity type:Individual
Prefix:
First Name:TRACY
Middle Name:LYNN
Last Name:LEEMAN
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:TRACY
Other - Middle Name:LYNN
Other - Last Name:LEEMAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LMT
Mailing Address - Street 1:7740 ALLEN RD
Mailing Address - Street 2:
Mailing Address - City:ALLEN PARK
Mailing Address - State:MI
Mailing Address - Zip Code:48101-1795
Mailing Address - Country:US
Mailing Address - Phone:313-383-4263
Mailing Address - Fax:
Practice Address - Street 1:7740 ALLEN RD
Practice Address - Street 2:
Practice Address - City:ALLEN PARK
Practice Address - State:MI
Practice Address - Zip Code:48101-1795
Practice Address - Country:US
Practice Address - Phone:313-383-4263
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-05
Last Update Date:2015-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI7501004677225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist