Provider Demographics
NPI:1942804539
Name:DELEON, TIMOTEA MALORIE (LPTA)
Entity Type:Individual
Prefix:
First Name:TIMOTEA
Middle Name:MALORIE
Last Name:DELEON
Suffix:
Gender:F
Credentials:LPTA
Other - Prefix:
Other - First Name:TIMOTEA
Other - Middle Name:MALORIE
Other - Last Name:DELEON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3822 GRANITE PEAK DR
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78410-2208
Mailing Address - Country:US
Mailing Address - Phone:509-270-4566
Mailing Address - Fax:
Practice Address - Street 1:11110 TOM ADAMS DR
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78753-3354
Practice Address - Country:US
Practice Address - Phone:509-270-4566
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-24
Last Update Date:2020-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2158104225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant