Provider Demographics
NPI:1174389068
Name:LUNA, LESLIE (LMT)
Entity type:Individual
Prefix:
First Name:LESLIE
Middle Name:
Last Name:LUNA
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5501 INDEPENDENCE PKWY STE 202B
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75023-5445
Mailing Address - Country:US
Mailing Address - Phone:945-233-5453
Mailing Address - Fax:
Practice Address - Street 1:5501 INDEPENDENCE PKWY STE 202B
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75023-5445
Practice Address - Country:US
Practice Address - Phone:945-233-5453
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-27
Last Update Date:2024-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXMT112536225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist