Provider Demographics
NPI:1548867419
Name:AVILES, LEAH JEAN (DPT)
Entity type:Individual
Prefix:
First Name:LEAH
Middle Name:JEAN
Last Name:AVILES
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:LEAH
Other - Middle Name:
Other - Last Name:O'REILLY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:4715 ATLANTA DR
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92115-3511
Mailing Address - Country:US
Mailing Address - Phone:805-748-7217
Mailing Address - Fax:
Practice Address - Street 1:251 LANDIS AVE
Practice Address - Street 2:
Practice Address - City:CHULA VISTA
Practice Address - State:CA
Practice Address - Zip Code:91910-2628
Practice Address - Country:US
Practice Address - Phone:619-515-2500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-05
Last Update Date:2024-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA298792225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist