Provider Demographics
NPI:1174354062
Name:LEYVA, ANESSA MARIE (PT, DPT)
Entity type:Individual
Prefix:DR
First Name:ANESSA
Middle Name:MARIE
Last Name:LEYVA
Suffix:
Gender:F
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 1:260 VININGS WAY BLVD # 303
Mailing Address - Street 2:
Mailing Address - City:DESTIN
Mailing Address - State:FL
Mailing Address - Zip Code:32541-5349
Mailing Address - Country:US
Mailing Address - Phone:863-599-1732
Mailing Address - Fax:
Practice Address - Street 1:35008 EMERALD COAST PKWY STE 400
Practice Address - Street 2:
Practice Address - City:DESTIN
Practice Address - State:FL
Practice Address - Zip Code:32541-4753
Practice Address - Country:US
Practice Address - Phone:850-714-6166
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-12
Last Update Date:2024-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT42091225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist