Provider Demographics
NPI:1053047050
Name:LEONARD, MADISON
Entity type:Individual
Prefix:
First Name:MADISON
Middle Name:
Last Name:LEONARD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:444 COUNTY ROAD 130
Mailing Address - Street 2:
Mailing Address - City:BONO
Mailing Address - State:AR
Mailing Address - Zip Code:72416-8285
Mailing Address - Country:US
Mailing Address - Phone:870-340-6500
Mailing Address - Fax:
Practice Address - Street 1:1218 STONE ST
Practice Address - Street 2:
Practice Address - City:JONESBORO
Practice Address - State:AR
Practice Address - Zip Code:72401-4528
Practice Address - Country:US
Practice Address - Phone:870-336-0220
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-01
Last Update Date:2022-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR4762225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant