Individual
LESLIE A DETIENNE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
5934 US HIGHWAY 6, PORTAGE, IN 46368-4946
(219) 762-7136
Mailing address
577 SIENNA AVE, PORTAGE, IN 46368-2560
(219) 840-0572
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
—
—
Other
Enumeration date
05/28/2008
Last updated
05/28/2008
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