Provider Demographics
NPI:1023372281
Name:DE LEON, GILBERTO (PT,DPT)
Entity type:Individual
Prefix:MR
First Name:GILBERTO
Middle Name:
Last Name:DE LEON
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 1:1616 E GRIFFIN PARKWAY PMB 184
Mailing Address - Street 2:
Mailing Address - City:MISSION
Mailing Address - State:TX
Mailing Address - Zip Code:78572-8477
Mailing Address - Country:US
Mailing Address - Phone:956-583-2995
Mailing Address - Fax:
Practice Address - Street 1:1616 E GRIFFIN PKWY # 184
Practice Address - Street 2:
Practice Address - City:MISSION
Practice Address - State:TX
Practice Address - Zip Code:78572-3180
Practice Address - Country:US
Practice Address - Phone:956-583-2995
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-07-02
Last Update Date:2024-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1192973225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX3148652-01Medicaid