=====================================================
General NPI Number Information
=====================================================
NPI Number | 1497053896
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JUDITH KAY LEPPANEN LMT
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/09/2011
-----------------------------------------------------
Last Update Date | 03/09/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3410 E DEBAZAN AVE
-----------------------------------------------------
City | ST PETE BEACH
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33706-4064
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 727-367-0151
-----------------------------------------------------
Fax | 727-360-5026
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4615 GULF BLVD SUITE 113
-----------------------------------------------------
City | ST PETE BEACH
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33706-2462
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 727-367-0151
-----------------------------------------------------
Fax | 727-360-5026
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225700000X
-----------------------------------------------------
Taxonomy Name | Massage Therapist
-----------------------------------------------------
License Number | MA0026189
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------