Provider Demographics
NPI:1568851723
Name:GOUDEAU, LEON (DPT)
Entity Type:Individual
Prefix:
First Name:LEON
Middle Name:
Last Name:GOUDEAU
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9822 POTRANCO RD STE 112
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78251-9608
Mailing Address - Country:US
Mailing Address - Phone:726-800-7227
Mailing Address - Fax:726-800-7254
Practice Address - Street 1:9822 POTRANCO RD STE 112
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78251-9608
Practice Address - Country:US
Practice Address - Phone:726-800-7227
Practice Address - Fax:726-800-7254
Is Sole Proprietor?:No
Enumeration Date:2015-01-12
Last Update Date:2023-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX12539312251X0800X, 225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic