MEDICARE: ELLIE LEITKO PT, DPT

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	225100000X	Physical Therapist	1408340	TX

General Provider Information

NPI Number	:	1235069097
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELLIE LEITKO PT, DPT

Provider Business Mailing Address
First Line	:	9235 ESCONDIDO DR
Second Line	:
City	:	WILLIS
State	:	TX
Zip	:	77318-6620
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2700 W SAM HOUSTON PKWY N
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77043-1608
Country	:	US
Telephone Number	:	713-367-1260
Fax Number	:

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

Provider Enumeration Date	:	05/21/2026
Last Update Date	:	05/21/2026

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