Provider Demographics
NPI:1538634456
Name:LEONARD, RUSSELL T (DPT)
Entity Type:Individual
Prefix:DR
First Name:RUSSELL
Middle Name:T
Last Name:LEONARD
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 1:1712 WHEELER RD
Mailing Address - Street 2:
Mailing Address - City:BAY CITY
Mailing Address - State:MI
Mailing Address - Zip Code:48706-9482
Mailing Address - Country:US
Mailing Address - Phone:989-274-6141
Mailing Address - Fax:
Practice Address - Street 1:946 W MIDLAND RD
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:MI
Practice Address - Zip Code:48611-9400
Practice Address - Country:US
Practice Address - Phone:989-662-8855
Practice Address - Fax:989-266-3195
Is Sole Proprietor?:No
Enumeration Date:2018-10-07
Last Update Date:2021-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501018784225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist