Provider Demographics
NPI:1811365141
Name:LEONARD, PETER C (DPT, PT)
Entity Type:Individual
Prefix:DR
First Name:PETER
Middle Name:C
Last Name:LEONARD
Suffix:
Gender:M
Credentials:DPT, PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:533 COVERED BRIDGE RD
Mailing Address - Street 2:
Mailing Address - City:CHERRY HILL
Mailing Address - State:NJ
Mailing Address - Zip Code:08034-3110
Mailing Address - Country:US
Mailing Address - Phone:609-458-2768
Mailing Address - Fax:856-858-3235
Practice Address - Street 1:759 HADDON AVE
Practice Address - Street 2:
Practice Address - City:COLLINGSWOOD
Practice Address - State:NJ
Practice Address - Zip Code:08108-3714
Practice Address - Country:US
Practice Address - Phone:609-458-2768
Practice Address - Fax:856-858-3235
Is Sole Proprietor?:No
Enumeration Date:2015-09-03
Last Update Date:2015-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA01642500225100000X
IDPT-4162225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist