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General NPI Number Information
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NPI Number | 1609380476
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Entity Type | Individual
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Provider Name | LEANNA SUZETTE JOHNSON BLACKBURN
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Gender | Female
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Dates
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Enumeration Date | 11/30/2017
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Last Update Date | 01/14/2018
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Provider Practice Location Address
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Address Line | 5424 W BROAD ST
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City | COLUMBUS
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State | OH
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Zip | 43228-1155
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Country | US
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Telephone | 614-870-7288
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Fax | 614-870-7288
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Provider Business Mailing Address
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Address Line | 3100 LEWIS RD
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City | COLUMBUS
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State | OH
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Zip | 43207-3701
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Country | US
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Telephone | 614-632-0529
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Fax | 614-350-8708
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | 33.017176
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License Number State | OH
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