=====================================================
General NPI Number Information
=====================================================
NPI Number | 1578365219
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | LESLIE FOUNTAIN WILLIAMS LMT
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/25/2025
-----------------------------------------------------
Last Update Date | 03/25/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 7504 86TH ST SW STE 150
-----------------------------------------------------
City | LAKEWOOD
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98498-6177
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 253-212-2036
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 8010 WASHINGTON BLVD SW APT 7
-----------------------------------------------------
City | LAKEWOOD
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98498-5407
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 585-503-2667
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
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 | MA61637570
-----------------------------------------------------
License Number State | WA
-----------------------------------------------------