Provider Demographics
NPI:1932448479
Name:BROWN, LEONARD KYLE (PT)
Entity Type:Individual
Prefix:
First Name:LEONARD
Middle Name:KYLE
Last Name:BROWN
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 152
Mailing Address - Street 2:
Mailing Address - City:VANSANT
Mailing Address - State:VA
Mailing Address - Zip Code:24656-0152
Mailing Address - Country:US
Mailing Address - Phone:276-935-6496
Mailing Address - Fax:276-935-5852
Practice Address - Street 1:1060 ANCHORAGE CIRCLE
Practice Address - Street 2:
Practice Address - City:VANSANT
Practice Address - State:VA
Practice Address - Zip Code:24656-9999
Practice Address - Country:US
Practice Address - Phone:276-935-6496
Practice Address - Fax:276-935-5852
Is Sole Proprietor?:No
Enumeration Date:2013-02-04
Last Update Date:2013-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305202480225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA047904OtherANTHEM
VA004978471Medicaid
VA047904OtherANTHEM