Provider Demographics
NPI:1225018310
Name:LEONE, MAURA (PT)
Entity Type:Individual
Prefix:
First Name:MAURA
Middle Name:
Last Name:LEONE
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1481 CHAPEL ST
Mailing Address - Street 2:
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06511-4305
Mailing Address - Country:US
Mailing Address - Phone:203-776-9110
Mailing Address - Fax:203-777-5879
Practice Address - Street 1:1481 CHAPEL ST
Practice Address - Street 2:
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06511-4305
Practice Address - Country:US
Practice Address - Phone:203-776-9110
Practice Address - Fax:203-777-5879
Is Sole Proprietor?:No
Enumeration Date:2006-01-17
Last Update Date:2019-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT004187225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT004187Medicare ID - Type UnspecifiedPT