Individual
KEEGAN L LEAVELL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LMT
Contact information
Practice address
1590 WILLOW CREEK RD, PRESCOTT, AZ 86301-1164
(928) 227-1899
Mailing address
1590 WILLOW CREEK RD, PRESCOTT, AZ 86301-1164
(928) 227-1899
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
MT-23594
AZ
Other
Enumeration date
04/19/2018
Last updated
04/19/2018
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