Provider Demographics
NPI:1609677343
Name:LEONHARDT, BALEIGH
Entity type:Individual
Prefix:
First Name:BALEIGH
Middle Name:
Last Name:LEONHARDT
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6831 N GALVESTON DR
Mailing Address - Street 2:
Mailing Address - City:MCCORDSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46055-9234
Mailing Address - Country:US
Mailing Address - Phone:765-309-8194
Mailing Address - Fax:
Practice Address - Street 1:5594 E 146TH ST
Practice Address - Street 2:
Practice Address - City:NOBLESVILLE
Practice Address - State:IN
Practice Address - Zip Code:46062-7070
Practice Address - Country:US
Practice Address - Phone:765-309-8194
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-20
Last Update Date:2025-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN05014703A225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist