Provider Demographics
NPI:1588691034
Name:CALDERON, LEONYD (MPT ATC/L)
Entity type:Individual
Prefix:MR
First Name:LEONYD
Middle Name:
Last Name:CALDERON
Suffix:
Gender:M
Credentials:MPT ATC/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10961 BURNT MILL RD
Mailing Address - Street 2:APT #923
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32256-4654
Mailing Address - Country:US
Mailing Address - Phone:904-997-9850
Mailing Address - Fax:904-292-0195
Practice Address - Street 1:12421 SAN JOSE BLVD
Practice Address - Street 2:SUITE 100
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32223-2680
Practice Address - Country:US
Practice Address - Phone:904-292-0195
Practice Address - Fax:904-292-0566
Is Sole Proprietor?:No
Enumeration Date:2006-06-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT22556225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLU7339ZMedicare ID - Type Unspecified