Provider Demographics
NPI:1104034925
Name:TEETER, LEON EARL (PTA)
Entity Type:Individual
Prefix:MR
First Name:LEON
Middle Name:EARL
Last Name:TEETER
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:124 RAINBOW DR
Mailing Address - Street 2:#2423
Mailing Address - City:LIVINGSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77399-0001
Mailing Address - Country:US
Mailing Address - Phone:210-315-5031
Mailing Address - Fax:
Practice Address - Street 1:1000 US HIGHWAY 82 E
Practice Address - Street 2:
Practice Address - City:SHERMAN
Practice Address - State:TX
Practice Address - Zip Code:75090-1704
Practice Address - Country:US
Practice Address - Phone:903-892-9708
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2050001225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant