Provider Demographics
NPI:1942279096
Name:LEONARD, LORI MICHI (MPT)
Entity Type:Individual
Prefix:MS
First Name:LORI
Middle Name:MICHI
Last Name:LEONARD
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15100 LOS GATOS BLVD
Mailing Address - Street 2:SUITE 1
Mailing Address - City:LOS GATOS
Mailing Address - State:CA
Mailing Address - Zip Code:95032-2028
Mailing Address - Country:US
Mailing Address - Phone:408-358-1460
Mailing Address - Fax:408-358-1459
Practice Address - Street 1:15100 LOS GATOS BLVD
Practice Address - Street 2:SUITE 1
Practice Address - City:LOS GATOS
Practice Address - State:CA
Practice Address - Zip Code:95032-2028
Practice Address - Country:US
Practice Address - Phone:408-358-1460
Practice Address - Fax:408-358-1459
Is Sole Proprietor?:No
Enumeration Date:2006-03-14
Last Update Date:2018-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT17905225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA0PT179052Medicare UPIN