Provider Demographics
NPI:1962967331
Name:LEONARD, JONISE M (LMA)
Entity type:Individual
Prefix:
First Name:JONISE
Middle Name:M
Last Name:LEONARD
Suffix:
Gender:F
Credentials:LMA
Other - Prefix:
Other - First Name:JONISE
Other - Middle Name:M
Other - Last Name:LEONARD
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LMT
Mailing Address - Street 1:7224 W COLONIAL DR
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32818-6743
Mailing Address - Country:US
Mailing Address - Phone:407-440-4051
Mailing Address - Fax:407-704-5981
Practice Address - Street 1:7224 W COLONIAL DR
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32818-6743
Practice Address - Country:US
Practice Address - Phone:407-440-4051
Practice Address - Fax:407-704-5981
Is Sole Proprietor?:No
Enumeration Date:2019-02-09
Last Update Date:2019-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA51473225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist