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General NPI Number Information
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NPI Number | 1538634456
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Entity Type | Individual
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Provider Name | RUSSELL T LEONARD DPT
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Gender | Male
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Dates
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Enumeration Date | 10/07/2018
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Last Update Date | 05/27/2021
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Provider Practice Location Address
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Address Line | 946 W MIDLAND RD
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City | AUBURN
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State | MI
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Zip | 48611-9400
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Country | US
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Telephone | 989-662-8855
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Fax | 989-266-3195
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Provider Business Mailing Address
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Address Line | 1712 WHEELER RD
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City | BAY CITY
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State | MI
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Zip | 48706-9482
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Country | US
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Telephone | 989-274-6141
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 5501018784
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License Number State | MI
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