Provider Demographics
NPI:1760021182
Name:GREENE, LEOLA DENISE (LMT)
Entity type:Individual
Prefix:MS
First Name:LEOLA
Middle Name:DENISE
Last Name:GREENE
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:MS
Other - First Name:LEOLA
Other - Middle Name:DENISE
Other - Last Name:DURDEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1231 BELL TOWER ARCH
Mailing Address - Street 2:
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23324-3176
Mailing Address - Country:US
Mailing Address - Phone:757-641-7592
Mailing Address - Fax:
Practice Address - Street 1:1231 BELL TOWER ARCH
Practice Address - Street 2:
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23324-3176
Practice Address - Country:US
Practice Address - Phone:757-641-7592
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-02
Last Update Date:2020-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0019016095225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist