Provider Demographics
NPI:1740804939
Name:LEONIDAS, RILLOUX (PT, DPT)
Entity type:Individual
Prefix:
First Name:RILLOUX
Middle Name:
Last Name:LEONIDAS
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 100174
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11210-0174
Mailing Address - Country:US
Mailing Address - Phone:718-600-9432
Mailing Address - Fax:
Practice Address - Street 1:3728 AVENUE K
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11210-4809
Practice Address - Country:US
Practice Address - Phone:718-600-9432
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-03
Last Update Date:2021-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305213274225100000X
SC10051225100000X
NJ40QA01947500225100000X
NY045942225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist