MEDICARE: ANNIA FERNANDA LEIJA 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	2251X0800X	Orthopedic Physical Therapist	1312508	TX
2	2251P0200X	Pediatric Physical Therapist	1312508	TX

General Provider Information

NPI Number	:	1518422351
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANNIA FERNANDA LEIJA DPT

Provider Business Mailing Address
First Line	:	116 CAS HILLS DR
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78213-3322
Country	:	US
Telephone Number	:	210-303-2201
Fax Number	:

Provider Business Practice Location Address
First Line	:	1635 NE LOOP 410 STE 600
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78209-1619
Country	:	US
Telephone Number	:	210-457-2000
Fax Number	:

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

Provider Enumeration Date	:	02/06/2019
Last Update Date	:	02/06/2019

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