Provider Demographics
NPI:1801142294
Name:PRIDDY, LEDDY MCCALL (PT, DPT)
Entity type:Individual
Prefix:DR
First Name:LEDDY
Middle Name:MCCALL
Last Name:PRIDDY
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:DR
Other - First Name:LEDDY
Other - Middle Name:LAVONNE
Other - Last Name:MCCALL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT, DPT
Mailing Address - Street 1:1001 SALLEE ROAD
Mailing Address - Street 2:
Mailing Address - City:SAN ANGELO
Mailing Address - State:TX
Mailing Address - Zip Code:76904-9732
Mailing Address - Country:US
Mailing Address - Phone:325-223-6394
Mailing Address - Fax:325-223-6408
Practice Address - Street 1:4601 HARTFORD ST
Practice Address - Street 2:
Practice Address - City:ABILENE
Practice Address - State:TX
Practice Address - Zip Code:79605-4603
Practice Address - Country:US
Practice Address - Phone:325-223-6304
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-08-03
Last Update Date:2014-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1219569225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist