Individual
MYLIE BROOKE LEATHERMAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LAT, ATC
Contact information
Practice address
700 S VICTORY WAY, KISSIMMEE, FL 34747
(407) 541-5600
Mailing address
PO BOX 471151, CELEBRATION, FL 34747-9151
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
AL4771
FL
Other
Enumeration date
02/23/2017
Last updated
02/23/2017
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