MEDICARE: LEIGH SCISCO PT, DPT

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
1	225100000X	Physical Therapist	40QA01474400	NJ
2	225100000X	Physical Therapist	1275270	TX

General Provider Information

NPI Number	:	1851783351
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LEIGH SCISCO PT, DPT

Provider Business Mailing Address
First Line	:	400 CONCORD PLAZA DR STE 300
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78216-6991
Country	:	US
Telephone Number	:	210-804-5400
Fax Number	:

Provider Business Practice Location Address
First Line	:	3327 RESEARCH PLZ STE 215
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78235-5157
Country	:	US
Telephone Number	:	210-804-5400
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/21/2015
Last Update Date	:	10/02/2025

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