Provider Demographics
NPI:1033403621
Name:LEONARD, MARK J (PT, DPT)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:J
Last Name:LEONARD
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11018 HWY 18
Mailing Address - Street 2:3
Mailing Address - City:CONNEAUT LAKE
Mailing Address - State:PA
Mailing Address - Zip Code:16316-3556
Mailing Address - Country:US
Mailing Address - Phone:814-382-6570
Mailing Address - Fax:
Practice Address - Street 1:11018 HWY 18
Practice Address - Street 2:3
Practice Address - City:CONNEAUT LAKE
Practice Address - State:PA
Practice Address - Zip Code:16316-3556
Practice Address - Country:US
Practice Address - Phone:814-382-6570
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-06-01
Last Update Date:2011-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT021261225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist