MEDICARE: BREANA LEONG

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

General Provider Information

NPI Number	:	1366370124
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BREANA LEONG

Provider Business Mailing Address
First Line	:	1965 LINWOOD ST NW APT 117
Second Line	:
City	:	SALEM
State	:	OR
Zip	:	97304-2275
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4710 RIVER RD N
Second Line	:
City	:	KEIZER
State	:	OR
Zip	:	97303-4536
Country	:	US
Telephone Number	:	971-458-8235
Fax Number	:

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

Provider Enumeration Date	:	05/12/2026
Last Update Date	:	05/12/2026

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Directions to “ BREANA LEONG ” Practice Location

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