Provider Demographics
NPI:1942956263
Name:DE LEON, EVANGELINE (PT, DPT)
Entity Type:Individual
Prefix:
First Name:EVANGELINE
Middle Name:
Last Name:DE LEON
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2030 WESTMORELAND ST
Mailing Address - Street 2:
Mailing Address - City:FALLS CHURCH
Mailing Address - State:VA
Mailing Address - Zip Code:22043-1768
Mailing Address - Country:US
Mailing Address - Phone:703-940-3795
Mailing Address - Fax:
Practice Address - Street 1:2030 WESTMORELAND ST
Practice Address - Street 2:
Practice Address - City:FALLS CHURCH
Practice Address - State:VA
Practice Address - Zip Code:22043-1768
Practice Address - Country:US
Practice Address - Phone:703-940-3795
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-24
Last Update Date:2022-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305214667225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist