Provider Demographics
NPI:1669413910
Name:ANDERSON, LEON R III (PT)
Entity type:Individual
Prefix:MR
First Name:LEON
Middle Name:R
Last Name:ANDERSON
Suffix:III
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:PO BOX 378
Mailing Address - Street 2:
Mailing Address - City:SANDUSKY
Mailing Address - State:OH
Mailing Address - Zip Code:44871-0378
Mailing Address - Country:US
Mailing Address - Phone:419-626-6161
Mailing Address - Fax:419-502-3511
Practice Address - Street 1:3365 RICHMOND RD
Practice Address - Street 2:STE 110
Practice Address - City:BEACHWOOD
Practice Address - State:OH
Practice Address - Zip Code:44122-4116
Practice Address - Country:US
Practice Address - Phone:216-593-7070
Practice Address - Fax:216-593-7074
Is Sole Proprietor?:No
Enumeration Date:2006-06-09
Last Update Date:2020-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH052272251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7212196Medicaid
OHH643910OtherMEDICARE
OH2452180Medicaid
SCTH1794Medicaid
OH2452180Medicaid
SCTH1794Medicaid