Basic Information
| Provider Information | |||||||||
| NPI: | 1912080201 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | LEITZEL | ||||||||
| FirstName: | WILLIAM | ||||||||
| MiddleName: | ALFRED | ||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | MSPT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2 W 10TH ST | ||||||||
| Address2: | |||||||||
| City: | MARCUS HOOK | ||||||||
| State: | PA | ||||||||
| PostalCode: | 190614513 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6108598850 | ||||||||
| FaxNumber: | 6108597876 | ||||||||
| Practice Location | |||||||||
| Address1: | 283 SECOND STREET PIKE | ||||||||
| Address2: | SUITE145 | ||||||||
| City: | SOUTHAMPTON | ||||||||
| State: | PA | ||||||||
| PostalCode: | 189663823 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2154942255 | ||||||||
| FaxNumber: | 2154342258 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/23/2006 | ||||||||
| LastUpdateDate: | 06/14/2010 | ||||||||
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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 | PT013985L | PA | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
ID Information
| ID | Type | State | Issuer | Description | 1160735 | 01 | PA | KEYSTONE MERCY | OTHER | P0069308 | 01 | PA | MEDICARE RAILROAD | OTHER | P0039457 | 01 | DE | MEDICARE RAILROAD | OTHER | 1341106 | 01 | PA | HIGHMARK PABS | OTHER | 01884608 | 05 | PA | MEDICAID | 0188460801 | 01 | PA | AMERICHOICE | OTHER | 2033765000 | 01 | PA | IBC | OTHER |