Healthcare Provider Details

I. General information

NPI: 1336792001
Provider Name (Legal Business Name): LESLIE HARPER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/22/2019
Last Update Date: 07/22/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4169 LAMSON AVE
SPRING HILL FL
34608-3707
US

IV. Provider business mailing address

4169 LAMSON AVE
SPRING HILL FL
34608-3707
US

V. Phone/Fax

Practice location:
  • Phone: 352-596-7887
  • Fax:
Mailing address:
  • Phone: 352-596-7887
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier58733
Identifier TypeMEDICAID
Identifier StateFL
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: