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NPI Code Detail

MEDICARE: MRS. BROOKE MARIE LEONARD PTA

MEDICARE: MRS. BROOKE MARIE LEONARD PTA
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
1225200000XPhysical Therapy Assistant001418IA

General Provider Information

NPI Number : 1376109579
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. BROOKE MARIE LEONARD PTA
Provider Business Mailing Address
First Line : 963 HEATHER DR
Second Line :
City : PEOSTA
State : IA
Zip : 52068-9452
Country : US
Telephone Number : 563-513-8819
Fax Number :
Provider Business Practice Location Address
First Line : 3375 LAKE RIDGE DR
Second Line :
City : DUBUQUE
State : IA
Zip : 52003-7864
Country : US
Telephone Number : 563-207-8932
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/13/2019
Last Update Date : 05/13/2019

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