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NPI Code Detail

MEDICARE: JUAN RODRIGO LEIJA JR.

MEDICARE: JUAN RODRIGO LEIJA JR.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225100000XPhysical Therapist1293079TX

General Provider Information

NPI Number : 1023537107
Entity Type Code : Individual
Provider Name (Legal Business Name) : JUAN RODRIGO LEIJA JR.
Provider Business Mailing Address
First Line : 790 REMINGTON BLVD
Second Line :
City : BOLINGBROOK
State : IL
Zip : 60440-4909
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 11219 POTRANCO RD STE A110
Second Line :
City : SAN ANTONIO
State : TX
Zip : 78253-5848
Country : US
Telephone Number : 210-679-6900
Fax Number : 210-679-6904
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/11/2017
Last Update Date : 06/21/2024

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