Provider Demographics
NPI:1285925446
Name:LEAHY, CINDY (LMT)
Entity type:Individual
Prefix:MRS
First Name:CINDY
Middle Name:
Last Name:LEAHY
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2181SW BAYSHORE BLVD
Mailing Address - Street 2:
Mailing Address - City:PORT ST LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34984-2446
Mailing Address - Country:US
Mailing Address - Phone:772-878-1752
Mailing Address - Fax:772-878-1752
Practice Address - Street 1:2181 SW BAYSHORE BLVD
Practice Address - Street 2:
Practice Address - City:PORT ST LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34984
Practice Address - Country:US
Practice Address - Phone:772-878-1752
Practice Address - Fax:772-878-1752
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-22
Last Update Date:2014-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA0003191174400000X
FLMA3191225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
No174400000XOther Service ProvidersSpecialist