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NPI Code Detail

MEDICARE: MRS. KERRY ELLEN LEONARD LPT, CPRP

MEDICARE: MRS. KERRY ELLEN LEONARD LPT, CPRP
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1175T00000XPeer SpecialistSPBGQWKMOZRYCHFECA
2225400000XRehabilitation PractitionerNACA
3167G00000XLicensed Psychiatric TechnicianPT30252CA

General Provider Information

NPI Number : 1396864856
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. KERRY ELLEN LEONARD LPT, CPRP
Provider Business Mailing Address
First Line : 2677 ZOE AVE STE 304
Second Line :
City : HUNTINGTON PARK
State : CA
Zip : 90255-3699
Country : US
Telephone Number : 310-772-9738
Fax Number :
Provider Business Practice Location Address
First Line : 2677 ZOE AVE STE 304
Second Line :
City : HUNTINGTON PARK
State : CA
Zip : 90255-3699
Country : US
Telephone Number : 310-772-9738
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/28/2007
Last Update Date : 09/14/2023

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