Healthcare Provider Details

I. General information

NPI: 1659511905
Provider Name (Legal Business Name): CATHLEEN LEONARD RPT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/26/2009
Last Update Date: 02/26/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2460 WARM SPRINGS RD
GLEN ELLEN CA
95442-8714
US

IV. Provider business mailing address

PO BOX 661
GLEN ELLEN CA
95442-0661
US

V. Phone/Fax

Practice location:
  • Phone: 707-738-9679
  • Fax:
Mailing address:
  • Phone: 707-738-9679
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number857
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License Number857
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: