Provider Demographics
NPI:1437811692
Name:DIAZ, JUSTIN ANTHONY DE LEON (PT)
Entity type:Individual
Prefix:
First Name:JUSTIN ANTHONY
Middle Name:DE LEON
Last Name:DIAZ
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:141 BUENOS AIRES
Mailing Address - Street 2:
Mailing Address - City:KYLE
Mailing Address - State:TX
Mailing Address - Zip Code:78640-3120
Mailing Address - Country:US
Mailing Address - Phone:808-679-7067
Mailing Address - Fax:
Practice Address - Street 1:302 MEDICAL PKWY
Practice Address - Street 2:
Practice Address - City:LAKEWAY
Practice Address - State:TX
Practice Address - Zip Code:78738-5632
Practice Address - Country:US
Practice Address - Phone:512-827-0226
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-06
Last Update Date:2025-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIPT-4670225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist