MEDICARE: MS. LEANDRE M TANKERSLEY MT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225700000X	Massage Therapist	33007896	OH

General Provider Information

NPI Number	:	1063630424
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. LEANDRE M TANKERSLEY MT

Provider Business Mailing Address
First Line	:	3710 STATE ROUTE 668 S
Second Line	:
City	:	JUNCTION CITY
State	:	OH
Zip	:	43748-9745
Country	:	US
Telephone Number	:	740-987-2053
Fax Number	:	740-987-2053

Provider Business Practice Location Address
First Line	:	3710 STATE ROUTE 668 S
Second Line	:
City	:	JUNCTION CITY
State	:	OH
Zip	:	43748-9745
Country	:	US
Telephone Number	:	740-987-2053
Fax Number	:	740-987-2053

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/23/2007
Last Update Date	:	06/14/2023

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