Healthcare Provider Details

I. General information

NPI: 1396671277
Provider Name (Legal Business Name): LEAH MCKELLOP LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/19/2026
Last Update Date: 06/19/2026
Certification Date: 06/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6519 DICKENS PL
RICHMOND VA
23230-2001
US

IV. Provider business mailing address

303 FRANKLIN ST APT 300
SOUTH HILL VA
23970-2053
US

V. Phone/Fax

Practice location:
  • Phone: 804-397-9075
  • Fax:
Mailing address:
  • Phone: 203-770-1494
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number0019020487
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: