Provider Demographics
NPI:1245480839
Name:LEIBEL, JASMINE MARIE (DPT)
Entity type:Individual
Prefix:
First Name:JASMINE
Middle Name:MARIE
Last Name:LEIBEL
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1700 ADAMS AVE
Mailing Address - Street 2:SUITE 201
Mailing Address - City:COSTA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:92626-4865
Mailing Address - Country:US
Mailing Address - Phone:714-556-1600
Mailing Address - Fax:
Practice Address - Street 1:1700 ADAMS AVE
Practice Address - Street 2:SUITE 201
Practice Address - City:COSTA MESA
Practice Address - State:CA
Practice Address - Zip Code:92626-4865
Practice Address - Country:US
Practice Address - Phone:714-556-1600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-09-19
Last Update Date:2009-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT60041864225100000X
CA34358225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist