Provider Demographics
NPI:1326383258
Name:LEGASPI, ENRICO TEJO (DPT)
Entity Type:Individual
Prefix:DR
First Name:ENRICO
Middle Name:TEJO
Last Name:LEGASPI
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:DR
Other - First Name:XANDER
Other - Middle Name:TEJO
Other - Last Name:LEGASPI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DPT
Mailing Address - Street 1:1200 CORPORATE DR STE 400
Mailing Address - Street 2:
Mailing Address - City:HOOVER
Mailing Address - State:AL
Mailing Address - Zip Code:35242-5424
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:9514 GRAVELLY LAKE DR SW STE W18
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:WA
Practice Address - Zip Code:98499-1514
Practice Address - Country:US
Practice Address - Phone:253-433-7140
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-12-04
Last Update Date:2021-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT 39644225100000X
WAPT60740770225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGV059ZMedicare PIN