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NPI Code Detail

MEDICARE: TOMMY LE PT,DPT

MEDICARE: TOMMY LE PT,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
12251G0304XGeriatric Physical Therapist1248837TX

General Provider Information

NPI Number : 1679053565
Entity Type Code : Individual
Provider Name (Legal Business Name) : TOMMY LE PT,DPT
Provider Business Mailing Address
First Line : 3408 SEDONA DR
Second Line :
City : GRAND PRAIRIE
State : TX
Zip : 75052-7855
Country : US
Telephone Number : 469-774-2584
Fax Number :
Provider Business Practice Location Address
First Line : 7100 MATLOCK RD
Second Line :
City : ARLINGTON
State : TX
Zip : 76002-3402
Country : US
Telephone Number : 817-466-2511
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/20/2018
Last Update Date : 08/20/2018

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