MEDICARE: LEILA ANSARI

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	225200000X	Physical Therapy Assistant	PTA34142	FL

General Provider Information

NPI Number	:	1588537146
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LEILA ANSARI

Provider Business Mailing Address
First Line	:	4636 N FRIDAY CIR
Second Line	:
City	:	COCOA
State	:	FL
Zip	:	32926-3402
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	626 N ALAFAYA TRL STE 209
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32828-4353
Country	:	US
Telephone Number	:	407-658-4637
Fax Number	:

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

Provider Enumeration Date	:	09/29/2025
Last Update Date	:	09/29/2025

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Directions to “ LEILA ANSARI ” Practice Location

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