Jeanette Ellen Leal, LAT, ATC
Individual provider Active NPI Athletic Trainer · Glenville, WV
NPI 1730726951 · NPPES record last updated May 22, 2024
Key facts
- NPI
- 1730726951
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Athletic Trainer 2255A2300X
- License
- 088931 (IA)
- Practice address
- 200 High St
Glenville, WV 26351-1200 - Phone
- (304) 462-7361
- NPI assigned
- Dec 6, 2019
- Sex
- Female
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 088931 | IA | MD | Athletic Trainer |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Athletic Trainer | 2255A2300X | 088931 | IA | Yes |
Addresses
Primary practice location
200 High St
Glenville, WV 26351-1200
Mailing address
907 Walnut St Apt a
Glenville, WV 26351-1355
Other providers in Glenville, WV
- Jesse Michael Kennedy
- Tana Renee Kevak
- Kathleen Kimble
- Robin King
- Todd A. Lares
- Susan Quinn Lilly
- Heidi Lynn Lindsay
- Little Kanawha Family Medicine PLLC
- Jamie Losh
- Peggy Losh
All providers in Glenville, WV · Athletic Trainer in West Virginia
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on May 22, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.