Provider Demographics
NPI:1811233224
Name:LEONARD, JACQUELYN (MS, ATC, CES, CSCS)
Entity Type:Individual
Prefix:
First Name:JACQUELYN
Middle Name:
Last Name:LEONARD
Suffix:
Gender:F
Credentials:MS, ATC, CES, CSCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:261 BLUESTONE DR
Mailing Address - Street 2:MSC 2301, GODWIN 128
Mailing Address - City:HARRISONBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22807-1009
Mailing Address - Country:US
Mailing Address - Phone:540-568-2973
Mailing Address - Fax:
Practice Address - Street 1:1024 TOPPIN BLVD
Practice Address - Street 2:
Practice Address - City:HARRISONBURG
Practice Address - State:VA
Practice Address - Zip Code:22801-1631
Practice Address - Country:US
Practice Address - Phone:540-578-3811
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-13
Last Update Date:2014-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA01260010512255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer