Healthcare Provider Details

I. General information

NPI: 1255385167
Provider Name (Legal Business Name): LEO B RAMIN PT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/22/2006
Last Update Date: 12/26/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

951 PRIM AVE SUITE 18
GRACEVILLE FL
32440-2505
US

IV. Provider business mailing address

2813 MAGNOLIA BLOSSOM LN
MARIANNA FL
32446-6395
US

V. Phone/Fax

Practice location:
  • Phone: 850-360-5016
  • Fax:
Mailing address:
  • Phone: 850-209-3007
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License NumberPT10317
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: