Provider Demographics
NPI:1043610082
Name:DANZA, LEANDRA (DPT)
Entity Type:Individual
Prefix:
First Name:LEANDRA
Middle Name:
Last Name:DANZA
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1931 RICHMOND AVE STE 203
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10314-3889
Mailing Address - Country:US
Mailing Address - Phone:718-477-1911
Mailing Address - Fax:718-477-1971
Practice Address - Street 1:1931 RICHMOND AVE STE 203
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10314
Practice Address - Country:US
Practice Address - Phone:718-477-1911
Practice Address - Fax:718-477-1971
Is Sole Proprietor?:No
Enumeration Date:2014-08-27
Last Update Date:2018-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY038-139225100000X
NY038139-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist