Provider Demographics
NPI:1871906388
Name:LEONARD, CHRISTOPHER LYLE (ATC, LAT, CSCS)
Entity type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:LYLE
Last Name:LEONARD
Suffix:
Gender:M
Credentials:ATC, LAT, CSCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1318 OREGON AVE
Mailing Address - Street 2:
Mailing Address - City:LENOX
Mailing Address - State:IA
Mailing Address - Zip Code:50851-8133
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1318 OREGON AVE
Practice Address - Street 2:
Practice Address - City:LENOX
Practice Address - State:IA
Practice Address - Zip Code:50851-8133
Practice Address - Country:US
Practice Address - Phone:402-650-1557
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-03
Last Update Date:2014-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA0010412255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer