Active NPI
Leonard Buckridge Hall, PT
- Contractor
- San Luis Obispo, CA
National Provider Identifier
1043644149
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Contractor
- License
- 20618
- Practice address
- California Mens Colony Highway 1
San Luis Obispo, CA 93409-0001 - Phone
- (805) 547-7900
- NPI assigned
- Aug 26, 2013
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Contractor | 171W00000X | 20618 | CA | Primary |
Addresses
Primary practice location
California Mens Colony Highway 1
San Luis Obispo, CA 93409-0001
Mailing address
4434 Matich Dr
Reno, NV 89502-6375
Phone (775) 772-7466
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 20618 | CA | MD | Contractor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1377475200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1377475200000",
"number": "1043644149",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4434 MATICH DR",
"city": "RENO",
"state": "NV",
"postal_code": "895026375",
"telephone_number": "775-772-7466"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "CALIFORNIA MENS COLONY HIGHWAY 1",
"city": "SAN LUIS OBISPO",
"state": "CA",
"postal_code": "934090001",
"telephone_number": "805-547-7900"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HALL",
"first_name": "LEONARD",
"middle_name": "BUCKRIDGE",
"name_prefix": "Mr.",
"credential": "PT",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2013-08-26",
"last_updated": "2013-08-26",
"status": "A"
},
"taxonomies": [
{
"code": "171W00000X",
"taxonomy_group": "",
"desc": "Contractor",
"state": "CA",
"license": "20618",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in San Luis Obispo, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 26, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.