Provider Demographics
NPI:1023792215
Name:LEYDET, ANDREW JAMES (PT DPT)
Entity type:Individual
Prefix:
First Name:ANDREW
Middle Name:JAMES
Last Name:LEYDET
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 1:223970 LAURIE ANN LN
Mailing Address - Street 2:
Mailing Address - City:WAUSAU
Mailing Address - State:WI
Mailing Address - Zip Code:54401-4141
Mailing Address - Country:US
Mailing Address - Phone:715-297-6054
Mailing Address - Fax:
Practice Address - Street 1:3507 S MERCY RD STE 105
Practice Address - Street 2:
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85297-0441
Practice Address - Country:US
Practice Address - Phone:480-926-0404
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-09
Last Update Date:2023-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLPT-33019225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist