Provider Demographics
NPI:1306018932
Name:LEONARD, EDWARD STEVEN (PT)
Entity Type:Individual
Prefix:
First Name:EDWARD
Middle Name:STEVEN
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 1:1008 PINE VW
Mailing Address - Street 2:
Mailing Address - City:NEW WINDSOR
Mailing Address - State:NY
Mailing Address - Zip Code:12553-4902
Mailing Address - Country:US
Mailing Address - Phone:845-522-4464
Mailing Address - Fax:
Practice Address - Street 1:1008 PINE VW
Practice Address - Street 2:
Practice Address - City:NEW WINDSOR
Practice Address - State:NY
Practice Address - Zip Code:12553-4902
Practice Address - Country:US
Practice Address - Phone:845-522-4464
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-24
Last Update Date:2010-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY20049-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYQ15A810Medicare UPIN