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General NPI Number Information
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NPI Number | 1306516935
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Entity Type | Individual
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Provider Name | NICOLE E LEITCH PT, DPT
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Gender | Female
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Dates
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Enumeration Date | 09/15/2021
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Last Update Date | 09/15/2021
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Provider Practice Location Address
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Address Line | 1707 FOUNTAINVIEW DR
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City | MANSFIELD
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State | TX
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Zip | 76063-5091
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Country | US
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Telephone | 817-752-9662
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Fax |
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Provider Business Mailing Address
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Address Line | 1352 MEADOWBROOK LN
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City | CROWLEY
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State | TX
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Zip | 76036-3424
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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 |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 2251P0200X
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Taxonomy Name | Pediatric Physical Therapist
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License Number | 1351133
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License Number State | TX
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