MEDICARE: MS. QUEENETTA LEFLORE JR.

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
1	225700000X	Massage Therapist	MT012960	GA

General Provider Information

NPI Number	:	1588271423
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. QUEENETTA LEFLORE JR.

Provider Business Mailing Address
First Line	:	1475 SAND BAY DR SW APT 3007
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30331-8989
Country	:	US
Telephone Number	:	571-235-9967
Fax Number	:

Provider Business Practice Location Address
First Line	:	1475 SAND BAY DR SW APT 3007
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30331-8989
Country	:	US
Telephone Number	:	571-235-9967
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/24/2020
Last Update Date	:	09/24/2020

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Directions to “ MS. QUEENETTA LEFLORE JR. ” Practice Location

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