Provider Demographics
NPI:1174714893
Name:LESECA, ANTHONY (PT)
Entity type:Individual
Prefix:
First Name:ANTHONY
Middle Name:
Last Name:LESECA
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21957 MIKHAIL ST
Mailing Address - Street 2:
Mailing Address - City:SANTA CLARITA
Mailing Address - State:CA
Mailing Address - Zip Code:91390-5720
Mailing Address - Country:US
Mailing Address - Phone:661-803-7384
Mailing Address - Fax:661-263-6463
Practice Address - Street 1:21957 MIKHAIL ST
Practice Address - Street 2:
Practice Address - City:SANTA CLARITA
Practice Address - State:CA
Practice Address - Zip Code:91390-5720
Practice Address - Country:US
Practice Address - Phone:661-803-7384
Practice Address - Fax:661-263-6463
Is Sole Proprietor?:No
Enumeration Date:2007-08-07
Last Update Date:2007-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAWPT28266B2251G0304X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251G0304XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGeriatrics