MEDICARE: MR. JOSE ARCHIBALD DE LEON OCA 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	225100000X	Physical Therapist	15455	FL

General Provider Information

NPI Number	:	1548483563
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JOSE ARCHIBALD DE LEON OCA PT

Provider Business Mailing Address
First Line	:	4106 MENDOZA AVE
Second Line	:
City	:	SEBRING
State	:	FL
Zip	:	33872-1923
Country	:	US
Telephone Number	:	863-314-8765
Fax Number	:	863-471-2015

Provider Business Practice Location Address
First Line	:	6120 US HIGHWAY 27 N
Second Line	:
City	:	SEBRING
State	:	FL
Zip	:	33870-1221
Country	:	US
Telephone Number	:	863-471-1223
Fax Number	:	863-471-2015

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

Provider Enumeration Date	:	04/10/2007
Last Update Date	:	07/08/2007

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