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Individual
MRS. TINA MARIE LEAVENWORTH
Active
Individual
MRS. TINA MARIE LEAVENWORTH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LMT
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
18135
OR
225700000X
Massage Therapist
Primary
18135
OR
Other
Enumeration date
05/10/2011
Last updated
12/10/2020
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