| NPI | 1538451430 |
|---|---|
| Former Name | TINA MARIE LEAVENWORTH |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225700000X Massage Therapist (Licence: OR 18135) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: OR 18135) |
| Enumeration Date | 2011-05-10 |
| Last Update Date | 2020-12-10 |