Provider Demographics
NPI:1851692818
Name:LEONARD, HANNEKE (LMT)
Entity Type:Individual
Prefix:MRS
First Name:HANNEKE
Middle Name:
Last Name:LEONARD
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3135 BOUNTIFUL BLVD
Mailing Address - Street 2:
Mailing Address - City:BOUNTIFUL
Mailing Address - State:UT
Mailing Address - Zip Code:84010-3208
Mailing Address - Country:US
Mailing Address - Phone:801-201-9297
Mailing Address - Fax:
Practice Address - Street 1:3135 BOUNTIFUL BLVD
Practice Address - Street 2:
Practice Address - City:BOUNTIFUL
Practice Address - State:UT
Practice Address - Zip Code:84010-3208
Practice Address - Country:US
Practice Address - Phone:801-201-9297
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-08
Last Update Date:2010-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT69082634701225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist