Provider Demographics
NPI:1114025186
Name:LEONARD, PATRICK (PT)
Entity Type:Individual
Prefix:MR
First Name:PATRICK
Middle Name:
Last Name:LEONARD
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 144
Mailing Address - Street 2:
Mailing Address - City:CHESTER
Mailing Address - State:NJ
Mailing Address - Zip Code:07930-0144
Mailing Address - Country:US
Mailing Address - Phone:908-879-8111
Mailing Address - Fax:908-879-9940
Practice Address - Street 1:154 US ROUTE 206
Practice Address - Street 2:SUITE 1C
Practice Address - City:CHESTER
Practice Address - State:NJ
Practice Address - Zip Code:07930
Practice Address - Country:US
Practice Address - Phone:908-879-8111
Practice Address - Fax:908-879-9940
Is Sole Proprietor?:No
Enumeration Date:2006-09-21
Last Update Date:2023-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA00556500225100000X
NJQA00556500225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
831395Medicare PIN