Provider Demographics
NPI:1396811097
Name:LEONARDI, CHARLENE YVONNE (MPT)
Entity type:Individual
Prefix:MRS
First Name:CHARLENE
Middle Name:YVONNE
Last Name:LEONARDI
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 1:1368 HOLLIDAY DR
Mailing Address - Street 2:
Mailing Address - City:LAKE ORION
Mailing Address - State:MI
Mailing Address - Zip Code:48362-3719
Mailing Address - Country:US
Mailing Address - Phone:248-693-3174
Mailing Address - Fax:
Practice Address - Street 1:5210 HIGHLAND RD
Practice Address - Street 2:
Practice Address - City:WATERFORD
Practice Address - State:MI
Practice Address - Zip Code:48327-1970
Practice Address - Country:US
Practice Address - Phone:248-674-8855
Practice Address - Fax:248-674-0188
Is Sole Proprietor?:No
Enumeration Date:2006-11-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501010434225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist