Basic Information
| Provider Information | |||||||||
| NPI: | 1912171331 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | LEON | ||||||||
| FirstName: | RANDI | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1417 RIDGEWOOD LN | ||||||||
| Address2: | |||||||||
| City: | NEWTOWN | ||||||||
| State: | PA | ||||||||
| PostalCode: | 189403734 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2159681611 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2250 HICKORY RD | ||||||||
| Address2: | SUITE 240 | ||||||||
| City: | PLYMOUTH MEETING | ||||||||
| State: | PA | ||||||||
| PostalCode: | 194621047 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6108341122 | ||||||||
| FaxNumber: | 6108347525 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/16/2008 | ||||||||
| LastUpdateDate: | 04/16/2008 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 011262-L | PA | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.