Provider Demographics
NPI:1346856481
Name:ARCHULETA, LEAH (LNMT)
Entity type:Individual
Prefix:
First Name:LEAH
Middle Name:
Last Name:ARCHULETA
Suffix:
Gender:F
Credentials:LNMT
Other - Prefix:
Other - First Name:LEAH
Other - Middle Name:
Other - Last Name:ARCHULETA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LNMT
Mailing Address - Street 1:1303 COVENTRY DR
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80906-5610
Mailing Address - Country:US
Mailing Address - Phone:719-334-8716
Mailing Address - Fax:
Practice Address - Street 1:2137 N ACADEMY BLVD
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80909-1507
Practice Address - Country:US
Practice Address - Phone:719-334-8716
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-22
Last Update Date:2020-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist