MEDICARE: REBEKAH LOUISE LEATHERMAN MASSAGE THERAPIST

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	LA9584	LA

General Provider Information

NPI Number	:	1952012627
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	REBEKAH LOUISE LEATHERMAN MASSAGE THERAPIST

Provider Business Mailing Address
First Line	:	CRESCENT KINETIC MASSAGE
Second Line	:	629 CHEROKEE ST 105
City	:	NEW OLEANS
State	:	LA
Zip	:	70118
Country	:	US
Telephone Number	:	504-814-9582
Fax Number	:

Provider Business Practice Location Address
First Line	:	4908 LAINE AVE
Second Line	:
City	:	NEW ORLEANS
State	:	LA
Zip	:	70126-4432
Country	:	US
Telephone Number	:	985-265-6654
Fax Number	:

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

Provider Enumeration Date	:	12/13/2022
Last Update Date	:	12/13/2022

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