Healthcare Provider Details

I. General information

NPI: 1760162267
Provider Name (Legal Business Name): LOS LEONES PHYSICAL THERAPY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/19/2023
Last Update Date: 07/19/2023
Certification Date: 07/19/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

67 W DAYTON ST
PASADENA CA
91105-2001
US

IV. Provider business mailing address

67 W DAYTON ST
PASADENA CA
91105-2001
US

V. Phone/Fax

Practice location:
  • Phone: 805-678-0469
  • Fax:
Mailing address:
  • Phone: 805-678-0469
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. LEONARDO MIGUEL VALENZUELA
Title or Position: OWNER
Credential: PT, DPT
Phone: 805-678-0469