| Organization Name: | LEESBURG SPORTS, INC. |
| NPI Number: | 1023033354 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | MICHAEL E TARVIN (VICE PRESIDENT & SECRETARY) |
| Mailing Address: | 17340 Pickwick Dr Suite 120 Purcellville |
| State: | VA US |
| Postal Code: | 201326181 |
| Phone Number: | 5403380685 |
| Fax Number: | 5403380687 |
| NPI Enumeration Date: | 07/13/2006 |
| NPI Last Update Date: | 05/01/2016 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QR0400X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Rehabilitation |
| Taxonomy Definition: | |