Provider Demographics
NPI:1467475020
Name:LEANDRO, CAROL LYN (PT)
Entity Type:Individual
Prefix:
First Name:CAROL
Middle Name:LYN
Last Name:LEANDRO
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 1:326 FAIRFAX AVE
Mailing Address - Street 2:
Mailing Address - City:VENTURA
Mailing Address - State:CA
Mailing Address - Zip Code:93003-2120
Mailing Address - Country:US
Mailing Address - Phone:805-652-4793
Mailing Address - Fax:
Practice Address - Street 1:1202 MARICOPA HWY
Practice Address - Street 2:STE. B
Practice Address - City:OJAI
Practice Address - State:CA
Practice Address - Zip Code:93023-3169
Practice Address - Country:US
Practice Address - Phone:805-646-4313
Practice Address - Fax:805-646-6318
Is Sole Proprietor?:No
Enumeration Date:2006-07-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT25834225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPT25834AMedicare ID - Type UnspecifiedPHYSICAL THERAPY