Provider Demographics
NPI:1669342333
Name:LEOPOLD, MITCHELL (LAT, ATC)
Entity type:Individual
Prefix:
First Name:MITCHELL
Middle Name:
Last Name:LEOPOLD
Suffix:
Gender:M
Credentials:LAT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:880 S VIEW DR
Mailing Address - Street 2:
Mailing Address - City:MOSINEE
Mailing Address - State:WI
Mailing Address - Zip Code:54455-8203
Mailing Address - Country:US
Mailing Address - Phone:715-298-2104
Mailing Address - Fax:
Practice Address - Street 1:880 S VIEW DR
Practice Address - Street 2:
Practice Address - City:MOSINEE
Practice Address - State:WI
Practice Address - Zip Code:54455-8203
Practice Address - Country:US
Practice Address - Phone:715-298-2104
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-11-07
Last Update Date:2025-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2288-392255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer