MEDICARE: BRIAN DE LEON

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225200000X	Physical Therapy Assistant

General Provider Information

NPI Number	:	1073219150
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRIAN DE LEON

Provider Business Mailing Address
First Line	:	2301 SW 139TH PL FL 33175
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33175-7040
Country	:	US
Telephone Number	:	813-770-9723
Fax Number	:

Provider Business Practice Location Address
First Line	:	1845 GARFIELD ST
Second Line	:
City	:	HOLLYWOOD
State	:	FL
Zip	:	33020-3115
Country	:	US
Telephone Number	:	954-505-8551
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/01/2023
Last Update Date	:	02/01/2023

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Directions to “ BRIAN DE LEON ” Practice Location

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