Healthcare Provider Details

I. General information

NPI: 1639645252
Provider Name (Legal Business Name): LEANNA KAYLEEN GUERRA LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/22/2018
Last Update Date: 05/30/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

849 NE 7TH ST
GRANTS PASS OR
97526-1634
US

IV. Provider business mailing address

491 OXYOKE RD
GRANTS PASS OR
97526-8732
US

V. Phone/Fax

Practice location:
  • Phone: 541-916-8585
  • Fax:
Mailing address:
  • Phone: 541-218-4735
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberLMT-22468
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: