Individual
MARY E LEAFBLAD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
ATC, LAT
Contact information
Practice address
14606 DALLAS PKWY APT 1100, DALLAS, TX 75254-7451
(715) 379-5838
Mailing address
14606 DALLAS PKWY APT 1100, DALLAS, TX 75254-7451
(715) 379-5838
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
AT5474
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
989154
NATIONAL CERTIFICATION NUMBER
—
01
—
AT5474
STATE LICENSURE
TX
Enumeration date
09/03/2024
Last updated
09/03/2024
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