Provider Demographics
NPI:1538598420
Name:DELONG, LEAH
Entity type:Individual
Prefix:
First Name:LEAH
Middle Name:
Last Name:DELONG
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1801 S JENTILLY LN STE C9
Mailing Address - Street 2:
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85281-5732
Mailing Address - Country:US
Mailing Address - Phone:480-553-2598
Mailing Address - Fax:
Practice Address - Street 1:1801 S JENTILLY LN
Practice Address - Street 2:SUITE C9
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85281-5758
Practice Address - Country:US
Practice Address - Phone:480-553-2598
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-01
Last Update Date:2017-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZMT-19053225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist