MEDICARE: TRINIDAD LEAL

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	1408342	TX

General Provider Information

NPI Number	:	1720919137
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TRINIDAD LEAL

Provider Business Mailing Address
First Line	:	1650 LYNDON FARM CT STE 300
Second Line	:
City	:	LOUISVILLE
State	:	KY
Zip	:	40223-5005
Country	:	US
Telephone Number	:	726-202-3039
Fax Number	:

Provider Business Practice Location Address
First Line	:	1212 W PARMER LN STE G
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78727-4657
Country	:	US
Telephone Number	:	512-670-3238
Fax Number	:	512-670-3241

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

Provider Enumeration Date	:	05/26/2026
Last Update Date	:	05/26/2026

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Directions to “ TRINIDAD LEAL ” Practice Location

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