Provider Demographics
NPI:1508887035
Name:LEITNER, PAMELA J (PT, DPT, OCS)
Entity Type:Individual
Prefix:MS
First Name:PAMELA
Middle Name:J
Last Name:LEITNER
Suffix:
Gender:F
Credentials:PT, DPT, OCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11077 PALMS BLVD APT 103
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90034-6162
Mailing Address - Country:US
Mailing Address - Phone:310-559-7990
Mailing Address - Fax:310-773-9876
Practice Address - Street 1:11077 PALMS BLVD APT 103
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90034-6162
Practice Address - Country:US
Practice Address - Phone:310-559-7990
Practice Address - Fax:310-559-7990
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-21
Last Update Date:2022-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT10902225100000X, 2251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPT10902Medicare ID - Type UnspecifiedPHYSICAL THERAPIST