Provider Demographics
NPI:1811675481
Name:LEONHARDT, SAMANTHA LAUREN (PT, DPT, CLT)
Entity type:Individual
Prefix:DR
First Name:SAMANTHA
Middle Name:LAUREN
Last Name:LEONHARDT
Suffix:
Gender:F
Credentials:PT, DPT, CLT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:378 MONTEITH DR
Mailing Address - Street 2:
Mailing Address - City:CHAPEL HILL
Mailing Address - State:NC
Mailing Address - Zip Code:27516-4265
Mailing Address - Country:US
Mailing Address - Phone:262-989-7791
Mailing Address - Fax:
Practice Address - Street 1:1125 HIGHWAY 54
Practice Address - Street 2:SUITE 503
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27707
Practice Address - Country:US
Practice Address - Phone:919-585-4655
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-05
Last Update Date:2023-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP22294225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist