Provider Demographics
NPI:1023223526
Name:HIPOLITO, LEONARDO C
Entity Type:Individual
Prefix:PROF
First Name:LEONARDO
Middle Name:C
Last Name:HIPOLITO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:204 EAST FIRST STREET
Mailing Address - Street 2:
Mailing Address - City:ALICE
Mailing Address - State:TX
Mailing Address - Zip Code:78332
Mailing Address - Country:US
Mailing Address - Phone:361-668-3776
Mailing Address - Fax:361-664-8955
Practice Address - Street 1:204 EAST FIRST STREET
Practice Address - Street 2:
Practice Address - City:ALICE
Practice Address - State:TX
Practice Address - Zip Code:78332
Practice Address - Country:US
Practice Address - Phone:361-668-3776
Practice Address - Fax:361-664-8955
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1103976225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist