1457665721 NPI number — LORREN SANDERS LEONARD PT, DPT

Table of content: LORREN SANDERS LEONARD PT, DPT (NPI 1457665721)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1457665721 NPI number — LORREN SANDERS LEONARD PT, DPT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LEONARD
Provider First Name:
LORREN
Provider Middle Name:
SANDERS
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PT, DPT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
SANDERS
Provider Other First Name:
LORREN
Provider Other Middle Name:
BRITTANY
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1457665721
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/18/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1648
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WARSAW
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
22572-1648
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
804-333-8222
Provider Business Mailing Address Fax Number:
804-333-8228

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4562 RICHMOND RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WARSAW
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
22572-3141
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
804-333-8222
Provider Business Practice Location Address Fax Number:
804-333-8228
Provider Enumeration Date:
07/29/2010

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  2305206524 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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