Provider Demographics
NPI:1174743983
Name:LEAL, JENNIFER (LAT, PT)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:LEAL
Suffix:
Gender:F
Credentials:LAT, PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1700 BUR OAK DR
Mailing Address - Street 2:
Mailing Address - City:ALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:75002-6395
Mailing Address - Country:US
Mailing Address - Phone:972-442-7755
Mailing Address - Fax:
Practice Address - Street 1:1700 BUR OAK DR
Practice Address - Street 2:
Practice Address - City:ALLEN
Practice Address - State:TX
Practice Address - Zip Code:75002-6395
Practice Address - Country:US
Practice Address - Phone:972-442-7755
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1114775225100000X
TXAT13062255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Not Answered2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer