Provider Demographics
NPI:1558528208
Name:LEOS, DEBRA ANN (CFTS)
Entity Type:Individual
Prefix:
First Name:DEBRA
Middle Name:ANN
Last Name:LEOS
Suffix:
Gender:F
Credentials:CFTS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2306 OAK LN
Mailing Address - Street 2:SUITE 3
Mailing Address - City:GRAND PRAIRIE
Mailing Address - State:TX
Mailing Address - Zip Code:75051-8235
Mailing Address - Country:US
Mailing Address - Phone:469-733-0580
Mailing Address - Fax:972-262-0533
Practice Address - Street 1:2306 OAK LN
Practice Address - Street 2:SUITE 3
Practice Address - City:GRAND PRAIRIE
Practice Address - State:TX
Practice Address - Zip Code:75051-8235
Practice Address - Country:US
Practice Address - Phone:469-733-0580
Practice Address - Fax:972-262-0533
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-20
Last Update Date:2008-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX332B00000X, 335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No335E00000XSuppliersProsthetic/Orthotic Supplier