MEDICARE: PEYTON OZ LEBLANC 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	225100000X	Physical Therapist	29796	MD
2	225100000X	Physical Therapist	11657	LA

General Provider Information

NPI Number	:	1699548859
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PEYTON OZ LEBLANC DPT

Provider Business Mailing Address
First Line	:	1151 BARATARIA BLVD STE 4300
Second Line	:
City	:	MARRERO
State	:	LA
Zip	:	70072-3084
Country	:	US
Telephone Number	:	504-934-8140
Fax Number	:	504-934-8044

Provider Business Practice Location Address
First Line	:	1151 BARATARIA BLVD STE 4300
Second Line	:
City	:	MARRERO
State	:	LA
Zip	:	70072-3084
Country	:	US
Telephone Number	:	504-934-8140
Fax Number	:	504-934-8044

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

Provider Enumeration Date	:	10/31/2023
Last Update Date	:	09/13/2024

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