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General NPI Number Information
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NPI Number | 1831271113
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Entity Type | Individual
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Provider Name | VICTORIA MARIE LEAKE PT, DPT, OCS
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Gender | Female
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Dates
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Enumeration Date | 10/19/2006
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Last Update Date | 08/26/2013
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Provider Practice Location Address
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Address Line | 801 E WILLIAM CANNON DR STE 225
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City | AUSTIN
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State | TX
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Zip | 78745-6646
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Country | US
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Telephone | 512-270-2060
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Fax | 512-270-2061
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Provider Business Mailing Address
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Address Line | 5114 BALCONES WOODS DR SUITE 306
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City | AUSTIN
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State | TX
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Zip | 78759-5273
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Country | US
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Telephone | 512-372-3612
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Fax | 512-372-3943
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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 | 1223538
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 2251X0800X
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Taxonomy Name | Orthopedic Physical Therapist
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License Number | PT017126
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License Number State | PA
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