Basic Information
| Provider Information | |||||||||
| NPI: | 1295081958 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LEONARD | ||||||||
| FirstName: | LAURA | ||||||||
| MiddleName: | LINDSAY | ||||||||
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| Credential: | DPT | ||||||||
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| OtherLastName: | LINDSAY | ||||||||
| OtherFirstName: | LAURA | ||||||||
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| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 350 NEW FIDELITY CT | ||||||||
| Address2: | |||||||||
| City: | GARNER | ||||||||
| State: | NC | ||||||||
| PostalCode: | 275292665 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9192582714 | ||||||||
| FaxNumber: | 4109872975 | ||||||||
| Practice Location | |||||||||
| Address1: | 34 W VIRGINIA WAY STE 1 | ||||||||
| Address2: | |||||||||
| City: | RANSON | ||||||||
| State: | WV | ||||||||
| PostalCode: | 254384882 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3047289090 | ||||||||
| FaxNumber: | 3047289087 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/31/2012 | ||||||||
| LastUpdateDate: | 10/10/2022 | ||||||||
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| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 10/10/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 24121 | MD | N | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | 225100000X | PT003907 | WV | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.