Provider Demographics
NPI:1255515680
Name:KOO, LEAHO
Entity type:Individual
Prefix:
First Name:LEAHO
Middle Name:
Last Name:KOO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:LEAHO
Other - Middle Name:
Other - Last Name:KOO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PT
Mailing Address - Street 1:4806 NORTH ORANGE BLOSSOM TRAIL
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32837
Mailing Address - Country:US
Mailing Address - Phone:407-206-3326
Mailing Address - Fax:
Practice Address - Street 1:4806 NORTH ORANGE BLOSSOM TRAIL
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32837
Practice Address - Country:US
Practice Address - Phone:407-206-3326
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-20
Last Update Date:2010-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY030773-1225100000X
FL25893225100000X
IL070016112225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist