Provider Demographics
NPI:1205225422
Name:LEONARD, TONYA
Entity Type:Individual
Prefix:
First Name:TONYA
Middle Name:
Last Name:LEONARD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 871
Mailing Address - Street 2:P.O. BOX 871
Mailing Address - City:CHATSWORTH
Mailing Address - State:GA
Mailing Address - Zip Code:30705-0871
Mailing Address - Country:US
Mailing Address - Phone:706-271-6282
Mailing Address - Fax:706-517-1385
Practice Address - Street 1:1006 GREEN RD
Practice Address - Street 2:1006 GREEN RD.
Practice Address - City:CHATSWORTH
Practice Address - State:GA
Practice Address - Zip Code:30705-2012
Practice Address - Country:US
Practice Address - Phone:706-271-6282
Practice Address - Fax:706-517-1385
Is Sole Proprietor?:No
Enumeration Date:2015-01-12
Last Update Date:2015-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0042052251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics