MEDICARE: JOHN SCOTT LEARD

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	225100000X	Physical Therapist	007125	CT
2	2255A2300X	Athletic Trainer

General Provider Information

NPI Number	:	1497715668
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOHN SCOTT LEARD

Provider Business Mailing Address
First Line	:	1 HORSESHOE CIR
Second Line	:
City	:	SIMSBURY
State	:	CT
Zip	:	06070-1722
Country	:	US
Telephone Number	:	860-651-9316
Fax Number	:

Provider Business Practice Location Address
First Line	:	200 BLOOMFIELD AVE
Second Line	:	ATHLETIC COMPLEX
City	:	WEST HARTFORD
State	:	CT
Zip	:	06117-1545
Country	:	US
Telephone Number	:	860-768-5335
Fax Number	:

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

Provider Enumeration Date	:	03/23/2006
Last Update Date	:	07/17/2013

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