MEDICARE: VICTOR G LEONOR PT

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

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	362	OTHER	TN	LICENSE #

General Provider Information

NPI Number	:	1861502528
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VICTOR G LEONOR PT

Provider Business Mailing Address
First Line	:	2009 MEMORIAL BLVD
Second Line	:
City	:	SPRINGFIELD
State	:	TN
Zip	:	37172
Country	:	US
Telephone Number	:	615-384-3836
Fax Number	:	615-384-2354

Provider Business Practice Location Address
First Line	:	2009 MEMORIAL BLVD
Second Line	:
City	:	SPRINGFIELD
State	:	TN
Zip	:	37172
Country	:	US
Telephone Number	:	615-384-3836
Fax Number	:	615-384-2354

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

Provider Enumeration Date	:	08/30/2006
Last Update Date	:	03/08/2023

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