MR. DERRICK ANDRE LEACH NPI 1568079911

NPI Information

NPI: 1568079911
Provider Name: MR. DERRICK ANDRE LEACH
Classification: Massage Therapist - 225700000X
Entity Type: Individual
Address:
5685 WASHAKIE PT
ELLENWOOD, GA
ZIP 30294
Phone: (404) 396-3850
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MR. Derrick Andre Leach is a massage therapist in Ellenwood, GA. The provider is an individual trained in the manipulation of tissues (as by rubbing, stroking, kneading, or tapping) with the hand or an instrument for remedial or hygienic purposes. MR. Derrick Andre Leach NPI is 1568079911. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a male.

The provider's business location address is:

5685 WASHAKIE PT
ELLENWOOD, GA
ZIP 30294-697
Phone: (404) 396-3850

The enumeration date for this NPI number is 9/29/2020 and was last updated on 9/29/2020.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	225700000X	Massage Therapist		MT008448	GEORGIA	Yes

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

NPI Synchronization or Removal

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