Provider Demographics
NPI:1013464338
Name:LEAL, STEPHANIE LEEANN (DPT)
Entity Type:Individual
Prefix:MRS
First Name:STEPHANIE
Middle Name:LEEANN
Last Name:LEAL
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:STEPHANIE
Other - Middle Name:LEEANN
Other - Last Name:RANGEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:2201 W LAMPASAS ST
Mailing Address - Street 2:
Mailing Address - City:ENNIS
Mailing Address - State:TX
Mailing Address - Zip Code:75119-5644
Mailing Address - Country:US
Mailing Address - Phone:469-256-2340
Mailing Address - Fax:469-256-2341
Practice Address - Street 1:2201 W LAMPASAS ST
Practice Address - Street 2:
Practice Address - City:ENNIS
Practice Address - State:TX
Practice Address - Zip Code:75119-5644
Practice Address - Country:US
Practice Address - Phone:469-256-2340
Practice Address - Fax:469-256-2341
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-02
Last Update Date:2021-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1278332225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1278332OtherTEXAS BOARD OF PHYSICAL THERAPY EXAMINERS