Provider Demographics
NPI:1912421405
Name:CROSS, LEANDRA (LMT, MMP)
Entity type:Individual
Prefix:MRS
First Name:LEANDRA
Middle Name:
Last Name:CROSS
Suffix:
Gender:F
Credentials:LMT, MMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1040 COUNTY ROAD 5066
Mailing Address - Street 2:
Mailing Address - City:LEONARD
Mailing Address - State:TX
Mailing Address - Zip Code:75452
Mailing Address - Country:US
Mailing Address - Phone:903-505-9912
Mailing Address - Fax:
Practice Address - Street 1:307 W COFFIN ST
Practice Address - Street 2:
Practice Address - City:DENISON
Practice Address - State:TX
Practice Address - Zip Code:75020-7605
Practice Address - Country:US
Practice Address - Phone:903-505-9912
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-27
Last Update Date:2017-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXMT125750225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist