Provider Demographics
NPI:1174149009
Name:LEATHERWOOD, RHIANNON M
Entity type:Individual
Prefix:
First Name:RHIANNON
Middle Name:M
Last Name:LEATHERWOOD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6758 COTTONWOOD TREE DR
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80927-4062
Mailing Address - Country:US
Mailing Address - Phone:719-388-3704
Mailing Address - Fax:
Practice Address - Street 1:715 DALE ST
Practice Address - Street 2:
Practice Address - City:FOUNTAIN
Practice Address - State:CO
Practice Address - Zip Code:80817-1736
Practice Address - Country:US
Practice Address - Phone:719-388-3704
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-16
Last Update Date:2020-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0015660225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist