Provider Demographics
NPI:1841525367
Name:SIMPKINS REHYANSKY, LESLI M (LMT)
Entity type:Individual
Prefix:
First Name:LESLI
Middle Name:M
Last Name:SIMPKINS REHYANSKY
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:LESLI
Other - Middle Name:M
Other - Last Name:REHYANSKY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LMT
Mailing Address - Street 1:1168 SE PROCTOR LN
Mailing Address - Street 2:
Mailing Address - City:PORT ST LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34983-3224
Mailing Address - Country:US
Mailing Address - Phone:772-873-5422
Mailing Address - Fax:
Practice Address - Street 1:1168 SE PROCTOR LN
Practice Address - Street 2:
Practice Address - City:PORT ST LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34983-3224
Practice Address - Country:US
Practice Address - Phone:772-873-5422
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-16
Last Update Date:2009-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA 47994225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist