Healthcare Provider Details

I. General information

NPI: 1295322386
Provider Name (Legal Business Name): LESLIE LYNN HUFFMAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/23/2020
Last Update Date: 05/23/2025
Certification Date: 05/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5016 RIVERSIDE DR STE C
DANVILLE VA
24541-5641
US

IV. Provider business mailing address

149 MILLERTON RD
DANVILLE VA
24540-2815
US

V. Phone/Fax

Practice location:
  • Phone: 419-788-7773
  • Fax:
Mailing address:
  • Phone: 419-788-7773
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number0019018721
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number33-022667
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: