Provider Demographics
NPI:1255649976
Name:RICHARD, LEON ANTHONY (PT, DPT, OCS, MSPT)
Entity Type:Individual
Prefix:DR
First Name:LEON
Middle Name:ANTHONY
Last Name:RICHARD
Suffix:
Gender:M
Credentials:PT, DPT, OCS, MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 TRADING BAY RD
Mailing Address - Street 2:SUITE 8
Mailing Address - City:KENAI
Mailing Address - State:AK
Mailing Address - Zip Code:99611-7786
Mailing Address - Country:US
Mailing Address - Phone:907-335-2490
Mailing Address - Fax:907-335-1956
Practice Address - Street 1:100 TRADING BAY RD
Practice Address - Street 2:SUITE 8
Practice Address - City:KENAI
Practice Address - State:AK
Practice Address - Zip Code:99611-7786
Practice Address - Country:US
Practice Address - Phone:907-335-2490
Practice Address - Fax:907-335-1956
Is Sole Proprietor?:No
Enumeration Date:2010-09-15
Last Update Date:2014-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK1829225100000X
MEPT2377225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist