Healthcare Provider Details

I. General information

NPI: 1326358797
Provider Name (Legal Business Name): LEANN DELACERDA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/19/2010
Last Update Date: 10/19/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9441 LBJ FWY
DALLAS TX
75243-4545
US

IV. Provider business mailing address

9441 LBJ FWY
DALLAS TX
75243-4545
US

V. Phone/Fax

Practice location:
  • Phone: 214-575-9820
  • Fax:
Mailing address:
  • Phone: 214-575-9820
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: