Provider Demographics
NPI:1881052348
Name:LEERS, EDWARD (DPT)
Entity type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:
Last Name:LEERS
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21820 PASEO DE LOS PORTALES RD
Mailing Address - Street 2:
Mailing Address - City:SONORA
Mailing Address - State:CA
Mailing Address - Zip Code:95370-9624
Mailing Address - Country:US
Mailing Address - Phone:209-345-7199
Mailing Address - Fax:
Practice Address - Street 1:21820 PASEO DE LOS PORTALES RD
Practice Address - Street 2:
Practice Address - City:SONORA
Practice Address - State:CA
Practice Address - Zip Code:95370-9624
Practice Address - Country:US
Practice Address - Phone:209-345-7199
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-29
Last Update Date:2016-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA42970225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist