Provider Demographics
NPI:1659511905
Name:LEONARD, CATHLEEN (RPT)
Entity Type:Individual
Prefix:
First Name:CATHLEEN
Middle Name:
Last Name:LEONARD
Suffix:
Gender:F
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 661
Mailing Address - Street 2:
Mailing Address - City:GLEN ELLEN
Mailing Address - State:CA
Mailing Address - Zip Code:95442-0661
Mailing Address - Country:US
Mailing Address - Phone:707-738-9679
Mailing Address - Fax:
Practice Address - Street 1:2460 WARM SPRINGS RD
Practice Address - Street 2:
Practice Address - City:GLEN ELLEN
Practice Address - State:CA
Practice Address - Zip Code:95442-8714
Practice Address - Country:US
Practice Address - Phone:707-738-9679
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-26
Last Update Date:2009-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA857225100000X, 2251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist