Provider Demographics
NPI:1881128734
Name:LEONARD, DANIELLE D (LAT)
Entity type:Individual
Prefix:
First Name:DANIELLE
Middle Name:D
Last Name:LEONARD
Suffix:
Gender:F
Credentials:LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1200 SYCAMORE ST
Mailing Address - Street 2:
Mailing Address - City:WAXAHACHIE
Mailing Address - State:TX
Mailing Address - Zip Code:75165-2397
Mailing Address - Country:US
Mailing Address - Phone:972-923-5477
Mailing Address - Fax:972-923-8191
Practice Address - Street 1:1200 SYCAMORE ST
Practice Address - Street 2:
Practice Address - City:WAXAHACHIE
Practice Address - State:TX
Practice Address - Zip Code:75165-2397
Practice Address - Country:US
Practice Address - Phone:972-923-5477
Practice Address - Fax:972-923-8191
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-18
Last Update Date:2017-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAT40462255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXAT4046OtherATHLETIC TRAINER