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NPI Code Detail

MEDICARE: LEAH MATTE M.T.

MEDICARE:   LEAH  MATTE  M.T.
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 Therapist10832-146WI

General Provider Information

NPI Number : 1740688183
Entity Type Code : Individual
Provider Name (Legal Business Name) : LEAH MATTE M.T.
Provider Business Mailing Address
First Line : 10731 W FOREST HOME AVE
Second Line :
City : HALES CORNERS
State : WI
Zip : 53130-2555
Country : US
Telephone Number : 920-217-1249
Fax Number :
Provider Business Practice Location Address
First Line : 10731 W FOREST HOME AVE
Second Line :
City : HALES CORNERS
State : WI
Zip : 53130-2555
Country : US
Telephone Number : 920-217-1249
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/17/2014
Last Update Date : 12/17/2014

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