Provider Demographics
NPI:1891084489
Name:SHOEMAKER, LEIGHANNA MARIE (MT)
Entity type:Individual
Prefix:MISS
First Name:LEIGHANNA
Middle Name:MARIE
Last Name:SHOEMAKER
Suffix:
Gender:F
Credentials:MT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1234 S 15TH ST
Mailing Address - Street 2:
Mailing Address - City:NOBLESVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46060-3853
Mailing Address - Country:US
Mailing Address - Phone:317-667-9913
Mailing Address - Fax:
Practice Address - Street 1:1234 S 15TH ST
Practice Address - Street 2:
Practice Address - City:NOBLESVILLE
Practice Address - State:IN
Practice Address - Zip Code:46060-3853
Practice Address - Country:US
Practice Address - Phone:317-667-9913
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-04
Last Update Date:2011-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
INMT20902730225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist