Provider Demographics
NPI:1649473273
Name:LEETCH, DYLAN DUANE I (CPED)
Entity type:Individual
Prefix:
First Name:DYLAN
Middle Name:DUANE
Last Name:LEETCH
Suffix:I
Gender:M
Credentials:CPED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22910 SHERIOAKS LN
Mailing Address - Street 2:
Mailing Address - City:SPRING
Mailing Address - State:TX
Mailing Address - Zip Code:77389-3926
Mailing Address - Country:US
Mailing Address - Phone:832-212-3050
Mailing Address - Fax:281-907-6689
Practice Address - Street 1:22910 SHERIOAKS LN
Practice Address - Street 2:
Practice Address - City:SPRING
Practice Address - State:TX
Practice Address - Zip Code:77389-3926
Practice Address - Country:US
Practice Address - Phone:832-212-3050
Practice Address - Fax:281-907-6689
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier