Provider Demographics
NPI:1063736445
Name:HUFFMAN, LEANDRA (LMT,CMT)
Entity type:Individual
Prefix:
First Name:LEANDRA
Middle Name:
Last Name:HUFFMAN
Suffix:
Gender:F
Credentials:LMT,CMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4836 WARRIOR DR
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:VA
Mailing Address - Zip Code:24153-5816
Mailing Address - Country:US
Mailing Address - Phone:304-952-1935
Mailing Address - Fax:
Practice Address - Street 1:3406 BRAMBLETON AVE
Practice Address - Street 2:
Practice Address - City:ROANOKE
Practice Address - State:VA
Practice Address - Zip Code:24018-6520
Practice Address - Country:US
Practice Address - Phone:304-952-1935
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-03-15
Last Update Date:2022-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV2009-2618225700000X
VA0019008505225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist