Provider Demographics
NPI:1265638431
Name:LEONARD, TOM (MT)
Entity Type:Individual
Prefix:MR
First Name:TOM
Middle Name:
Last Name:LEONARD
Suffix:
Gender:M
Credentials:MT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5040 NW 7 ST
Mailing Address - Street 2:SUITE 410
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33126-3431
Mailing Address - Country:US
Mailing Address - Phone:305-569-0263
Mailing Address - Fax:305-569-0283
Practice Address - Street 1:5040 NW 7 ST
Practice Address - Street 2:SUITE 410
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33126-3431
Practice Address - Country:US
Practice Address - Phone:305-569-0263
Practice Address - Fax:305-569-0283
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA44954225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist