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Contact Information

MYLIE B LEATHERMAN, LAT, ATC
700 S VICTORY WAY
KISSIMMEE, FL34747
 Phone: 407-541-5600
 Fax:
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Athletic Trainer

2255A2300X
Indicates primary specialty

NPI Profile & details for MYLIE B LEATHERMAN · (Female)

NPI # 1093254088
Status Active
Credentials LAT, ATC
Entity Individual
Enumeration date 02/23/2017
Last updated 02/23/2017 - About 9 years ago
Sole proprietor 1 Yes
Identifiers
  • FL License # AL4771
Hospital affiliation(s) Not Available
1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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