Provider Demographics
NPI:1528316858
Name:LEONARD, TARA LEE (NTS, LMT)
Entity type:Individual
Prefix:
First Name:TARA
Middle Name:LEE
Last Name:LEONARD
Suffix:
Gender:F
Credentials:NTS, LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:715 W. KENSINGTON #2D
Mailing Address - Street 2:
Mailing Address - City:MISSOULA
Mailing Address - State:MT
Mailing Address - Zip Code:59801
Mailing Address - Country:US
Mailing Address - Phone:406-728-6347
Mailing Address - Fax:406-273-4787
Practice Address - Street 1:715 W. KENSINGTON #2D
Practice Address - Street 2:
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59801
Practice Address - Country:US
Practice Address - Phone:406-728-6347
Practice Address - Fax:406-273-4787
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-16
Last Update Date:2012-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT984225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist