Healthcare Provider Details

I. General information

NPI: 1285557702
Provider Name (Legal Business Name): LEANDRA RENEE PALACIOS PTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/01/2026
Last Update Date: 08/01/2026
Certification Date: 08/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 LOUISIANA AVE STE 402
CORPUS CHRISTI TX
78404-2856
US

IV. Provider business mailing address

1001 LOUISIANA AVE STE 402
CORPUS CHRISTI TX
78404-2856
US

V. Phone/Fax

Practice location:
  • Phone: 361-853-0488
  • Fax: 361-853-0489
Mailing address:
  • Phone: 361-853-0488
  • Fax: 361-853-0489

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number2188658
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: