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General NPI Number Information
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NPI Number | 1073029336
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Entity Type | Individual
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Provider Name | ELISABETH ANNA LEYENDECKER PT, DPT
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Gender | Female
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Dates
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Enumeration Date | 12/22/2017
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Last Update Date | 12/22/2017
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Provider Practice Location Address
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Address Line | 6301 GASTON AVE STE 750
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City | DALLAS
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State | TX
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Zip | 75214-3922
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Country | US
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Telephone | 214-738-0750
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Fax |
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Provider Business Mailing Address
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Address Line | 7710 EL SANTO LN
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City | DALLAS
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State | TX
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Zip | 75248-4316
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2251P0200X
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Taxonomy Name | Pediatric Physical Therapist
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License Number | 1209686
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License Number State | TX
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