Provider Demographics
NPI:1407037849
Name:MITCHELL, LEONARD AUSTIN (DPT)
Entity Type:Individual
Prefix:
First Name:LEONARD
Middle Name:AUSTIN
Last Name:MITCHELL
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5247 SECLUDED OAKS DR
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32812-8129
Mailing Address - Country:US
Mailing Address - Phone:415-531-8193
Mailing Address - Fax:415-531-8193
Practice Address - Street 1:5247 SECLUDED OAKS DR
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32812-8129
Practice Address - Country:US
Practice Address - Phone:415-531-8193
Practice Address - Fax:415-531-8193
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-14
Last Update Date:2013-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT 24373225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist