Provider Demographics
NPI:1326338146
Name:TICMAN, LEILANI ESTRADA (PT)
Entity Type:Individual
Prefix:MS
First Name:LEILANI
Middle Name:ESTRADA
Last Name:TICMAN
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 1:3312 BRIAROAKS DRIVE
Mailing Address - Street 2:
Mailing Address - City:GARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:75044-7330
Mailing Address - Country:US
Mailing Address - Phone:972-487-5570
Mailing Address - Fax:972-487-5098
Practice Address - Street 1:705 WALTER REED BLVD
Practice Address - Street 2:
Practice Address - City:GARLAND
Practice Address - State:TX
Practice Address - Zip Code:75042-5726
Practice Address - Country:US
Practice Address - Phone:972-487-5570
Practice Address - Fax:972-487-5098
Is Sole Proprietor?:No
Enumeration Date:2011-04-13
Last Update Date:2011-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1040897225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist