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NPI Code Detail

MEDICARE: KEEGAN L LEAVELL LMT

MEDICARE: KEEGAN L LEAVELL LMT
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225700000XMassage TherapistMT-23594AZ

General Provider Information

NPI Number : 1225525751
Entity Type Code : Individual
Provider Name (Legal Business Name) : KEEGAN L LEAVELL LMT
Provider Business Mailing Address
First Line : 1590 WILLOW CREEK RD
Second Line :
City : PRESCOTT
State : AZ
Zip : 86301-1164
Country : US
Telephone Number : 928-227-1899
Fax Number :
Provider Business Practice Location Address
First Line : 1590 WILLOW CREEK RD
Second Line :
City : PRESCOTT
State : AZ
Zip : 86301-1164
Country : US
Telephone Number : 928-227-1899
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/19/2018
Last Update Date : 04/19/2018

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