Provider Demographics
NPI:1861502528
Name:LEONOR, VICTOR G (PT)
Entity Type:Individual
Prefix:
First Name:VICTOR
Middle Name:G
Last Name:LEONOR
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:VICTOR
Other - Middle Name:G
Other - Last Name:LEONOR
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PT
Mailing Address - Street 1:2009 MEMORIAL BLVD
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:TN
Mailing Address - Zip Code:37172
Mailing Address - Country:US
Mailing Address - Phone:615-384-3836
Mailing Address - Fax:615-384-2354
Practice Address - Street 1:2009 MEMORIAL BLVD
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:TN
Practice Address - Zip Code:37172
Practice Address - Country:US
Practice Address - Phone:615-384-3836
Practice Address - Fax:615-384-2354
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2023-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN362OtherLICENSE #