Provider Demographics
NPI:1154655686
Name:SANSANO, LEAH COSTALES (PT)
Entity Type:Individual
Prefix:MRS
First Name:LEAH
Middle Name:COSTALES
Last Name:SANSANO
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7520 ASTORIA BLVD
Mailing Address - Street 2:
Mailing Address - City:EAST ELMHURST
Mailing Address - State:NY
Mailing Address - Zip Code:11370-1138
Mailing Address - Country:US
Mailing Address - Phone:718-888-6920
Mailing Address - Fax:718-565-8539
Practice Address - Street 1:7520 ASTORIA BLVD
Practice Address - Street 2:
Practice Address - City:EAST ELMHURST
Practice Address - State:NY
Practice Address - Zip Code:11370-1138
Practice Address - Country:US
Practice Address - Phone:718-888-6920
Practice Address - Fax:718-565-8539
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-30
Last Update Date:2009-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY019392-1225100000X
CA27696225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist