Healthcare Provider Details

I. General information

NPI: 1013981760
Provider Name (Legal Business Name): SPORTS & ORTHOPEDIC LEADERS PHYSICAL THERAPY, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/16/2006
Last Update Date: 09/17/2025
Certification Date: 09/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4341 PIEDMONT AVE STE 201
OAKLAND CA
94611
US

IV. Provider business mailing address

4341 PIEDMONT AVE STE 201
OAKLAND CA
94611-4792
US

V. Phone/Fax

Practice location:
  • Phone: 510-547-1630
  • Fax:
Mailing address:
  • Phone: 616-356-5000
  • Fax: 616-356-5001

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name: MR. RICHARD LEAVER
Title or Position: CEO/OWNER
Credential: PT
Phone: 616-356-5000