Provider Demographics
NPI:1801851407
Name:LEONARD, TERRY A
Entity Type:Individual
Prefix:MS
First Name:TERRY
Middle Name:A
Last Name:LEONARD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2530 COLORADO AVE
Mailing Address - Street 2:SUITE 2A
Mailing Address - City:DURANGO
Mailing Address - State:CO
Mailing Address - Zip Code:81301-4760
Mailing Address - Country:US
Mailing Address - Phone:970-382-0321
Mailing Address - Fax:
Practice Address - Street 1:2530 COLORADO AVE
Practice Address - Street 2:SUITE 2A
Practice Address - City:DURANGO
Practice Address - State:CO
Practice Address - Zip Code:81301-4760
Practice Address - Country:US
Practice Address - Phone:970-382-0321
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO234171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist