MEDICARE: MRS. JOSEPHINE GALAN DE LEON PT

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	2251P0200X	Pediatric Physical Therapist	0343	NV

General Provider Information

NPI Number	:	1215084843
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. JOSEPHINE GALAN DE LEON PT

Provider Business Mailing Address
First Line	:	505 E WINDMILL LN
Second Line	:	#1 B-125
City	:	LAS VEGAS
State	:	NV
Zip	:	89123-1869
Country	:	US
Telephone Number	:	702-281-2552
Fax Number	:	702-361-7743

Provider Business Practice Location Address
First Line	:	505 E WINDMILL LN
Second Line	:	#1 B-125
City	:	LAS VEGAS
State	:	NV
Zip	:	89123-1869
Country	:	US
Telephone Number	:	702-281-2552
Fax Number	:	702-361-7743

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

Provider Enumeration Date	:	01/04/2007
Last Update Date	:	07/08/2007

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