Individual
LEANDRA JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RMT
Contact information
Practice address
7967 GLADWATER RD, PEYTON, CO 80831-6067
(719) 232-2653
Mailing address
7967 GLADWATER RD, PEYTON, CO 80831-6067
(719) 232-2653
Taxonomy
Speciality
Code
Description
License number
State
172M00000X
Mechanotherapist
Primary
MT-002445
CO
174400000X
Specialist
919508
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1710343595
MEDICAL MASSAGE THERAPY
CO
Enumeration date
07/16/2009
Last updated
04/13/2021
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