Healthcare Provider Details

I. General information

NPI: 1952586182
Provider Name (Legal Business Name): MELISSA A LEISENRING MPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/07/2008
Last Update Date: 05/28/2026
Certification Date: 05/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

706 THE RIALTO
VENICE FL
34285-3524
US

IV. Provider business mailing address

706 THE RIALTO
VENICE FL
34285-3524
US

V. Phone/Fax

Practice location:
  • Phone: 941-216-5753
  • Fax: 941-219-5310
Mailing address:
  • Phone: 941-216-5753
  • Fax: 941-219-5310

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT23799
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: