Provider Demographics
NPI:1831271113
Name:LEAKE, VICTORIA MARIE (PT, DPT, OCS)
Entity type:Individual
Prefix:DR
First Name:VICTORIA
Middle Name:MARIE
Last Name:LEAKE
Suffix:
Gender:F
Credentials:PT, DPT, OCS
Other - Prefix:MRS
Other - First Name:VICTORIA
Other - Middle Name:MARIE
Other - Last Name:KEITH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT, MPT
Mailing Address - Street 1:5114 BALCONES WOODS DR
Mailing Address - Street 2:SUITE 306
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78759-5273
Mailing Address - Country:US
Mailing Address - Phone:512-372-3612
Mailing Address - Fax:512-372-3943
Practice Address - Street 1:801 E WILLIAM CANNON DR
Practice Address - Street 2:STE 225
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78745-6646
Practice Address - Country:US
Practice Address - Phone:512-270-2060
Practice Address - Fax:512-270-2061
Is Sole Proprietor?:No
Enumeration Date:2006-10-19
Last Update Date:2013-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX12235382251X0800X
PAPT0171262251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic