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General NPI Number Information
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NPI Number | 1669123600
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Entity Type | Individual
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Provider Name | WESLEY WADE LEONARD
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Gender | Male
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Dates
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Enumeration Date | 01/11/2022
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Last Update Date | 01/11/2022
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Provider Practice Location Address
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Address Line | 115 BARTRAM OAKS WALK
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City | ST JOHNS
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State | FL
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Zip | 32259-3243
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Country | US
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Telephone | 904-217-3107
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Fax |
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Provider Business Mailing Address
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Address Line | 121 JARDIN DE MER PL
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City | JACKSONVILLE BEACH
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State | FL
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Zip | 32250-8609
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Country | US
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Telephone | 239-851-0085
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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 |
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License Number State |
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