Provider Demographics
NPI:1487242822
Name:LEUER, LEUNG YIN
Entity type:Individual
Prefix:
First Name:LEUNG
Middle Name:YIN
Last Name:LEUER
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 1:110 SAN BRISO WAY
Mailing Address - Street 2:
Mailing Address - City:ST AUGUSTINE
Mailing Address - State:FL
Mailing Address - Zip Code:32092-3116
Mailing Address - Country:US
Mailing Address - Phone:718-300-8692
Mailing Address - Fax:
Practice Address - Street 1:110 SAN BRISO WAY
Practice Address - Street 2:
Practice Address - City:ST AUGUSTINE
Practice Address - State:FL
Practice Address - Zip Code:32092-3116
Practice Address - Country:US
Practice Address - Phone:718-300-8692
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-31
Last Update Date:2020-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY029489225700000X
NJ18KT01291500225700000X
FLMA96401225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist