Active NPI
Mylie Brooke Leatherman, LAT, ATC
- Athletic Trainer
- Kissimmee, FL
National Provider Identifier
1093254088
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Athletic Trainer
- License
- AL4771
- Practice address
- 700 S Victory Way
Kissimmee, FL 34747 - Phone
- (407) 541-5600
- NPI assigned
- Feb 23, 2017
- Last updated
- Feb 23, 2017
- Sex
- Female
- 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 |
|---|---|---|---|---|
| Athletic Trainer | 2255A2300X | AL4771 | FL | Primary |
Addresses
Primary practice location
700 S Victory Way
Kissimmee, FL 34747
Mailing address
PO Box 471151
Celebration, FL 34747-9151
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 |
|---|---|---|---|
| AL4771 | FL | MD | Athletic Trainer |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1487808000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1487808000000",
"number": "1093254088",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 471151",
"city": "CELEBRATION",
"state": "FL",
"postal_code": "347479151"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "700 S VICTORY WAY",
"city": "KISSIMMEE",
"state": "FL",
"postal_code": "34747",
"telephone_number": "407-541-5600"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LEATHERMAN",
"first_name": "MYLIE",
"middle_name": "BROOKE",
"credential": "LAT, ATC",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2017-02-23",
"last_updated": "2017-02-23",
"status": "A"
},
"taxonomies": [
{
"code": "2255A2300X",
"taxonomy_group": "",
"desc": "Specialist/Technologist, Athletic Trainer",
"state": "FL",
"license": "AL4771",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Kissimmee, FL
- Nam-Hai Huynh Le, OTR/L
- Tri Le, M.D.
- Sharon Virginia Leal, LMT
- Learning Leaps Behavioral Services
- Learning Zone Academy LLC
- Leavitt Medical Associates of Florida Inc (Advanced Dermatology and Cosmetic Surgery)
- Deborah Ann Leblanc, PA-C
- Elizabeth Leblanc, LMT
- Natalie Leblanc, MASTERS COUNSELOR ED
- David Craig Lebowitz, M.D.
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 23, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.