Provider Demographics
NPI:1740582634
Name:DE LEON, MIRIAM GRACE (PT)
Entity Type:Individual
Prefix:MRS
First Name:MIRIAM
Middle Name:GRACE
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 1:1010 CENTRAL PARK AVE
Mailing Address - Street 2:
Mailing Address - City:YONKERS
Mailing Address - State:NY
Mailing Address - Zip Code:10704-1044
Mailing Address - Country:US
Mailing Address - Phone:914-964-4031
Mailing Address - Fax:
Practice Address - Street 1:1010 CENTRAL PARK AVE
Practice Address - Street 2:
Practice Address - City:YONKERS
Practice Address - State:NY
Practice Address - Zip Code:10704-1044
Practice Address - Country:US
Practice Address - Phone:914-964-4031
Practice Address - Fax:914-964-8889
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-26
Last Update Date:2010-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY012048225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist