MEDICARE: LEONARDO GALAM LEONOR 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	36152	CA

General Provider Information

NPI Number	:	1700118478
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LEONARDO GALAM LEONOR DPT

Provider Business Mailing Address
First Line	:	5530 E PACIFIC COAST HWY
Second Line	:
City	:	LONG BEACH
State	:	CA
Zip	:	90804-4469
Country	:	US
Telephone Number	:	949-413-3478
Fax Number	:

Provider Business Practice Location Address
First Line	:	5530 E PACIFIC COAST HWY
Second Line	:
City	:	LONG BEACH
State	:	CA
Zip	:	90804-4469
Country	:	US
Telephone Number	:	949-413-3478
Fax Number	:

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

Provider Enumeration Date	:	02/05/2010
Last Update Date	:	01/23/2022

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