Provider Demographics
NPI:1689017725
Name:LEEPER, TOSHIO RAUL (PT)
Entity Type:Individual
Prefix:
First Name:TOSHIO
Middle Name:RAUL
Last Name:LEEPER
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:TOSHIO
Other - Middle Name:RAUL
Other - Last Name:SIDNEY-ANDO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:1460 DREW AVE STE 200
Mailing Address - Street 2:
Mailing Address - City:DAVIS
Mailing Address - State:CA
Mailing Address - Zip Code:95618-4856
Mailing Address - Country:US
Mailing Address - Phone:530-753-9011
Mailing Address - Fax:530-753-9021
Practice Address - Street 1:1460 DREW AVE STE 200
Practice Address - Street 2:
Practice Address - City:DAVIS
Practice Address - State:CA
Practice Address - Zip Code:95618-4856
Practice Address - Country:US
Practice Address - Phone:530-753-9011
Practice Address - Fax:530-753-9021
Is Sole Proprietor?:No
Enumeration Date:2013-04-08
Last Update Date:2023-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT39939225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
W268Medicare PIN
CAW268Medicare PIN