Provider Demographics
NPI:1548483563
Name:DE LEON OCA, JOSE ARCHIBALD (PT)
Entity type:Individual
Prefix:MR
First Name:JOSE
Middle Name:ARCHIBALD
Last Name:DE LEON OCA
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
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Other - Middle Name:
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Mailing Address - Street 1:4106 MENDOZA AVE
Mailing Address - Street 2:
Mailing Address - City:SEBRING
Mailing Address - State:FL
Mailing Address - Zip Code:33872-1923
Mailing Address - Country:US
Mailing Address - Phone:863-314-8765
Mailing Address - Fax:863-471-2015
Practice Address - Street 1:6120 US HIGHWAY 27 N
Practice Address - Street 2:
Practice Address - City:SEBRING
Practice Address - State:FL
Practice Address - Zip Code:33870-1221
Practice Address - Country:US
Practice Address - Phone:863-471-1223
Practice Address - Fax:863-471-2015
Is Sole Proprietor?:No
Enumeration Date:2007-04-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FL15455225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist