Provider Demographics
NPI:1851926323
Name:CARRANZA, LEONARDO (DPT)
Entity Type:Individual
Prefix:
First Name:LEONARDO
Middle Name:
Last Name:CARRANZA
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:LEONARDO
Other - Middle Name:
Other - Last Name:CARRANZA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DPT
Mailing Address - Street 1:5100 ELDORADO PKWY # 10220EPT
Mailing Address - Street 2:
Mailing Address - City:MCKINNEY
Mailing Address - State:TX
Mailing Address - Zip Code:75070-6510
Mailing Address - Country:US
Mailing Address - Phone:972-939-0300
Mailing Address - Fax:972-939-0307
Practice Address - Street 1:1012 W HEBRON PKWY STE 124
Practice Address - Street 2:
Practice Address - City:CARROLLTON
Practice Address - State:TX
Practice Address - Zip Code:75010-1123
Practice Address - Country:US
Practice Address - Phone:972-939-0300
Practice Address - Fax:972-939-0307
Is Sole Proprietor?:No
Enumeration Date:2020-03-05
Last Update Date:2020-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1320983225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1320983OtherSTATE LICENSE