Healthcare Provider Details

I. General information

NPI: 1447384839
Provider Name (Legal Business Name): LILLI LEIHUA LEONG MSPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/15/2007
Last Update Date: 11/14/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19965 FM 3175
LYTLE TX
78052-3481
US

IV. Provider business mailing address

1215 GRUENE VINTAGE
NEW BRAUNFELS TX
78130-4424
US

V. Phone/Fax

Practice location:
  • Phone: 210-357-0300
  • Fax:
Mailing address:
  • Phone: 808-256-4463
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License NumberPT2089
License Number StateHI
# 2
Primary TaxonomyY
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License Number1199950
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: