Provider Demographics
NPI:1902314537
Name:LEON, VINCENT M
Entity Type:Individual
Prefix:
First Name:VINCENT
Middle Name:M
Last Name:LEON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2001 HARPER ST
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98404-4635
Mailing Address - Country:US
Mailing Address - Phone:916-844-9301
Mailing Address - Fax:
Practice Address - Street 1:3819 6TH AVE
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98406-4903
Practice Address - Country:US
Practice Address - Phone:916-844-9301
Practice Address - Fax:916-844-9301
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-17
Last Update Date:2018-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy