Provider Demographics
NPI:1184431637
Name:LEON, NORA (LAT, BOC)
Entity type:Individual
Prefix:
First Name:NORA
Middle Name:
Last Name:LEON
Suffix:
Gender:F
Credentials:LAT, BOC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8304 SOUTHERN PRAIRIE DR
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76123-2904
Mailing Address - Country:US
Mailing Address - Phone:817-925-4180
Mailing Address - Fax:
Practice Address - Street 1:201 S HURST RD
Practice Address - Street 2:
Practice Address - City:BURLESON
Practice Address - State:TX
Practice Address - Zip Code:76028-5052
Practice Address - Country:US
Practice Address - Phone:817-245-0250
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-17
Last Update Date:2024-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAT53012255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer