Provider Demographics
NPI:1053779934
Name:WARRINER, LEIGH ANN (MMT)
Entity type:Individual
Prefix:MRS
First Name:LEIGH ANN
Middle Name:
Last Name:WARRINER
Suffix:
Gender:F
Credentials:MMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7 MEDICAL LN
Mailing Address - Street 2:SUITE B
Mailing Address - City:CONWAY
Mailing Address - State:AR
Mailing Address - Zip Code:72034-4912
Mailing Address - Country:US
Mailing Address - Phone:501-205-1908
Mailing Address - Fax:
Practice Address - Street 1:7 MEDICAL LN
Practice Address - Street 2:SUITE B
Practice Address - City:CONWAY
Practice Address - State:AR
Practice Address - Zip Code:72034-4912
Practice Address - Country:US
Practice Address - Phone:501-205-1908
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-05
Last Update Date:2016-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR7479225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist