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General NPI Number Information
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NPI Number | 1689928152
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Entity Type | Individual
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Provider Name | LEONID KLICHINSKY DPT
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Gender | Male
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Dates
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Enumeration Date | 11/05/2012
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Last Update Date | 01/28/2019
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Provider Practice Location Address
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Address Line | 3876 SHELLEY RD
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City | HUNTINGDON VALLEY
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State | PA
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Zip | 19006-2343
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Country | US
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Telephone | 267-647-9097
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Fax | 215-914-9073
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Provider Business Mailing Address
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Address Line | 3876 SHELLEY RD
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City | HUNTINGDON VALLEY
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State | PA
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Zip | 19006-2343
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Country | US
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Telephone | 267-249-0877
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Fax | 215-914-9073
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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 | 2251X0800X
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Taxonomy Name | Orthopedic Physical Therapist
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License Number | PT021213
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License Number State | PA
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