MEDICARE: MR. LEON R ANDERSON III P.T.

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	05227	OH

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	H643910	OTHER	OH	MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1669413910
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. LEON R ANDERSON III P.T.

Provider Business Mailing Address
First Line	:	PO BOX 378
Second Line	:
City	:	SANDUSKY
State	:	OH
Zip	:	44871-0378
Country	:	US
Telephone Number	:	419-626-6161
Fax Number	:	419-502-3511

Provider Business Practice Location Address
First Line	:	3365 RICHMOND RD
Second Line	:	STE 110
City	:	BEACHWOOD
State	:	OH
Zip	:	44122-4116
Country	:	US
Telephone Number	:	216-593-7070
Fax Number	:	216-593-7074

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

Provider Enumeration Date	:	06/09/2006
Last Update Date	:	04/29/2020

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Directions to “ MR. LEON R ANDERSON III P.T.” Practice Location

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