Provider Demographics
NPI:1609052448
Name:DE LEON, MARIA CLEMENCIA (PT)
Entity Type:Individual
Prefix:MRS
First Name:MARIA
Middle Name:CLEMENCIA
Last Name:DE LEON
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 1:16612 NW 71ST CT
Mailing Address - Street 2:
Mailing Address - City:MIAMI LAKES
Mailing Address - State:FL
Mailing Address - Zip Code:33014-7105
Mailing Address - Country:US
Mailing Address - Phone:954-540-8907
Mailing Address - Fax:
Practice Address - Street 1:16612 NW 71ST CT
Practice Address - Street 2:
Practice Address - City:MIAMI LAKES
Practice Address - State:FL
Practice Address - Zip Code:33014-7105
Practice Address - Country:US
Practice Address - Phone:954-540-8907
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-10
Last Update Date:2016-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT3989225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
E 6986OtherMEDICARE