MEDICARE: LEAH K REYNOLDS

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	0012355	CO

General Provider Information

NPI Number	:	1831915594
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LEAH K REYNOLDS

Provider Business Mailing Address
First Line	:	436 SQUIRE ST
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80911-2336
Country	:	US
Telephone Number	:	719-271-5533
Fax Number	:

Provider Business Practice Location Address
First Line	:	6015 LEHMAN DR STE 202
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80918-3421
Country	:	US
Telephone Number	:	719-271-5533
Fax Number	:

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

Provider Enumeration Date	:	11/27/2024
Last Update Date	:	11/27/2024

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Directions to “ LEAH K REYNOLDS ” Practice Location

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