Individual
LEO J CORRAL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LAT, ATC
Contact information
Practice address
2101 E COLISEUM BLVD, FORT WAYNE, IN 46805-1445
(260) 481-6656
Mailing address
4434 CAMERON AVE, HAMMOND, IN 46327-1359
(708) 299-2795
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
—
—
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
10/03/2017
Last updated
02/28/2023
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