Provider Demographics
NPI:1780684662
Name:LEAL, JAVIER OMAR (MPT)
Entity Type:Individual
Prefix:MR
First Name:JAVIER
Middle Name:OMAR
Last Name:LEAL
Suffix:
Gender:M
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2001 S D ST
Mailing Address - Street 2:
Mailing Address - City:MCALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:78503-1854
Mailing Address - Country:US
Mailing Address - Phone:956-686-2242
Mailing Address - Fax:
Practice Address - Street 1:2001 S D ST
Practice Address - Street 2:
Practice Address - City:MCALLEN
Practice Address - State:TX
Practice Address - Zip Code:78503-1854
Practice Address - Country:US
Practice Address - Phone:956-686-2242
Practice Address - Fax:956-686-3515
Is Sole Proprietor?:No
Enumeration Date:2005-07-21
Last Update Date:2018-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1139020225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1718629-01Medicaid