Provider Demographics
NPI:1033764386
Name:LEOMBRUNO, DAVID HARRY (PTA)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:HARRY
Last Name:LEOMBRUNO
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 SAINT JACQUES AVE
Mailing Address - Street 2:
Mailing Address - City:CHICOPEE
Mailing Address - State:MA
Mailing Address - Zip Code:01020-4254
Mailing Address - Country:US
Mailing Address - Phone:774-766-2482
Mailing Address - Fax:
Practice Address - Street 1:11 SAINT ANTHONY ST
Practice Address - Street 2:
Practice Address - City:CHICOPEE
Practice Address - State:MA
Practice Address - Zip Code:01013-2141
Practice Address - Country:US
Practice Address - Phone:413-315-4205
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-05
Last Update Date:2019-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA9393225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant