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NPI Code Detail

MEDICARE: MICHAEL LEDESMA PTA

MEDICARE: MICHAEL LEDESMA PTA
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
1225200000XPhysical Therapy Assistant2135241TX

General Provider Information

NPI Number : 1982187290
Entity Type Code : Individual
Provider Name (Legal Business Name) : MICHAEL LEDESMA PTA
Provider Business Mailing Address
First Line : 7100 MATLOCK RD
Second Line :
City : ARLINGTON
State : TX
Zip : 76002-3402
Country : US
Telephone Number :
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 : 09/12/2018
Last Update Date : 09/12/2018

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Directions to “ MICHAEL LEDESMA PTA” Practice Location

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