Provider Demographics
NPI:1689690281
Name:LEEKE, PEYTON W (PT)
Entity Type:Individual
Prefix:
First Name:PEYTON
Middle Name:W
Last Name:LEEKE
Suffix:
Gender:M
Credentials:PT
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Mailing Address - Street 1:9850 GENESEE AVENUE
Mailing Address - Street 2:SUITE 210
Mailing Address - City:LA JOLLA
Mailing Address - State:CA
Mailing Address - Zip Code:92037
Mailing Address - Country:US
Mailing Address - Phone:858-535-1075
Mailing Address - Fax:858-453-9810
Practice Address - Street 1:4520 EXECUTIVE DRIVE
Practice Address - Street 2:SUITE 101
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92121
Practice Address - Country:US
Practice Address - Phone:858-535-1075
Practice Address - Fax:858-453-9810
Is Sole Proprietor?:No
Enumeration Date:2006-07-15
Last Update Date:2015-04-02
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAPT28169225100000X, 2251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic