Provider Demographics
NPI:1689401846
Name:THOMASSON, LEA BLYTHE (LMBT)
Entity type:Individual
Prefix:MS
First Name:LEA
Middle Name:BLYTHE
Last Name:THOMASSON
Suffix:
Gender:F
Credentials:LMBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1515 W NC HIGHWAY 54 STE 210
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27707-5576
Mailing Address - Country:US
Mailing Address - Phone:919-824-6838
Mailing Address - Fax:
Practice Address - Street 1:1515 W NC HIGHWAY 54 STE 210
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27707-5576
Practice Address - Country:US
Practice Address - Phone:919-824-6838
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-19
Last Update Date:2024-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC10124225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist