Basic Information
| Provider Information | |||||||||
| NPI: | 1548483563 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DE LEON OCA | ||||||||
| FirstName: | JOSE | ||||||||
| MiddleName: | ARCHIBALD | ||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | PT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4106 MENDOZA AVE | ||||||||
| Address2: | |||||||||
| City: | SEBRING | ||||||||
| State: | FL | ||||||||
| PostalCode: | 338721923 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8633148765 | ||||||||
| FaxNumber: | 8634712015 | ||||||||
| Practice Location | |||||||||
| Address1: | 6120 US HIGHWAY 27 N | ||||||||
| Address2: | |||||||||
| City: | SEBRING | ||||||||
| State: | FL | ||||||||
| PostalCode: | 338701221 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8634711223 | ||||||||
| FaxNumber: | 8634712015 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/10/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 15455 | FL | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.