Provider Demographics
NPI:1144571910
Name:AUSTRIA, LEONARDO CABEL JR (RPT)
Entity Type:Individual
Prefix:
First Name:LEONARDO
Middle Name:CABEL
Last Name:AUSTRIA
Suffix:JR
Gender:M
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9812 METROPOLITAN AVE
Mailing Address - Street 2:APT 2 FT
Mailing Address - City:FOREST HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11375-6628
Mailing Address - Country:US
Mailing Address - Phone:347-824-5042
Mailing Address - Fax:
Practice Address - Street 1:236 5TH AVE
Practice Address - Street 2:4TH FLOOR
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10001-7606
Practice Address - Country:US
Practice Address - Phone:212-686-0587
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-09-19
Last Update Date:2012-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY030079225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist