MEDICARE: AMANDA LEONG

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	309372	CA

General Provider Information

NPI Number	:	1740143270
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMANDA LEONG

Provider Business Mailing Address
First Line	:	312 GATES DR APT 511
Second Line	:
City	:	MILPITAS
State	:	CA
Zip	:	95035-8276
Country	:	US
Telephone Number	:	925-330-8827
Fax Number	:

Provider Business Practice Location Address
First Line	:	1045 E BROKAW RD
Second Line	:
City	:	SAN JOSE
State	:	CA
Zip	:	95131-2310
Country	:	US
Telephone Number	:	669-842-4989
Fax Number	:

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

Provider Enumeration Date	:	12/03/2025
Last Update Date	:	12/03/2025

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Directions to “ AMANDA LEONG ” Practice Location

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