Provider Demographics
NPI:1982180808
Name:LEONARD, DANIELLE R (DPT)
Entity Type:Individual
Prefix:
First Name:DANIELLE
Middle Name:R
Last Name:LEONARD
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:DANIELLE
Other - Middle Name:R
Other - Last Name:COLE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:14515 N OUTER 40 RD STE 110
Mailing Address - Street 2:
Mailing Address - City:CHESTERFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:63017-5746
Mailing Address - Country:US
Mailing Address - Phone:314-434-8680
Mailing Address - Fax:314-453-9985
Practice Address - Street 1:6744 CLAYTON RD STE 325
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63117-1639
Practice Address - Country:US
Practice Address - Phone:314-646-8300
Practice Address - Fax:314-646-8302
Is Sole Proprietor?:No
Enumeration Date:2018-07-13
Last Update Date:2020-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2018024972225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO2018024972OtherMISSOURI BOARD OF HEALING ARTS