Healthcare Provider Details

I. General information

NPI: 1548196967
Provider Name (Legal Business Name): LEAH KIDD LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/23/2026
Last Update Date: 06/23/2026
Certification Date: 06/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1018 RUCKER BLVD STE C
ENTERPRISE AL
36330-3688
US

IV. Provider business mailing address

206 WALNUT DR
ENTERPRISE AL
36330-1162
US

V. Phone/Fax

Practice location:
  • Phone: 334-494-5583
  • Fax:
Mailing address:
  • Phone: 334-494-5583
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number50086
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: