MEDICARE: MR. CRAIG PAUL LEONARD MSPT

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
1	174400000X	Specialist	PT008976L	PA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
3	045559PRL	OTHER	PA	MEDICARE ID

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2004000000	OTHER	PA	KEYSTONE HEALTH PLAN EAST
2	PA BLUE SHIELD	OTHER	PA	1311180
4	2004000000	OTHER	PA	AMERIHEALTH
5	2563889	OTHER	PA	AETNA/ US HEALTH CARE

General Provider Information

NPI Number	:	1578586566
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. CRAIG PAUL LEONARD MSPT

Provider Business Mailing Address
First Line	:	1585 WILLOW POND DR
Second Line	:
City	:	YARDLEY
State	:	PA
Zip	:	19067-5793
Country	:	US
Telephone Number	:	215-676-4070
Fax Number	:

Provider Business Practice Location Address
First Line	:	2869 HOLME AVE
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19152-2118
Country	:	US
Telephone Number	:	215-676-4070
Fax Number	:	215-676-4071

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/25/2006
Last Update Date	:	11/15/2007

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Directions to “ MR. CRAIG PAUL LEONARD MSPT” Practice Location

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