Provider Demographics
NPI:1831623438
Name:LEONARD, DANIEL (ATC)
Entity type:Individual
Prefix:
First Name:DANIEL
Middle Name:
Last Name:LEONARD
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 CIRCLE RD
Mailing Address - Street 2:INDOOR SPORTS COMPLEX
Mailing Address - City:STONY BROOK
Mailing Address - State:NY
Mailing Address - Zip Code:11794-3500
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:100 CIRCLE RD
Practice Address - Street 2:INDOOR SPORTS COMPLEX
Practice Address - City:STONY BROOK
Practice Address - State:NY
Practice Address - Zip Code:11794-3500
Practice Address - Country:US
Practice Address - Phone:631-632-7709
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-20
Last Update Date:2017-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY003378-12255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer