Provider Demographics
NPI:1255385167
Name:RAMIN, LEO B (PT)
Entity type:Individual
Prefix:
First Name:LEO
Middle Name:B
Last Name:RAMIN
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2813 MAGNOLIA BLOSSOM LN
Mailing Address - Street 2:
Mailing Address - City:MARIANNA
Mailing Address - State:FL
Mailing Address - Zip Code:32446-6395
Mailing Address - Country:US
Mailing Address - Phone:850-209-3007
Mailing Address - Fax:
Practice Address - Street 1:951 PRIM AVE
Practice Address - Street 2:SUITE 18
Practice Address - City:GRACEVILLE
Practice Address - State:FL
Practice Address - Zip Code:32440-2505
Practice Address - Country:US
Practice Address - Phone:850-360-5016
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-22
Last Update Date:2014-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT103172251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPENDINGMedicaid
FLPENDINGMedicaid