Provider Demographics
NPI:1497715668
Name:LEARD, JOHN SCOTT
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:SCOTT
Last Name:LEARD
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 HORSESHOE CIR
Mailing Address - Street 2:
Mailing Address - City:SIMSBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06070-1722
Mailing Address - Country:US
Mailing Address - Phone:860-651-9316
Mailing Address - Fax:
Practice Address - Street 1:200 BLOOMFIELD AVE
Practice Address - Street 2:ATHLETIC COMPLEX
Practice Address - City:WEST HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06117-1545
Practice Address - Country:US
Practice Address - Phone:860-768-5335
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-23
Last Update Date:2013-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT007125225100000X
2255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT650001340Medicare UPIN