Active NPI
Lexmor Yu De Leon, PT
- Physical Therapist
- Ellicott City, MD
National Provider Identifier
1174783575
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 5501013196
- Practice address
- 3290 N Ridge Rd
Suite 290
Ellicott City, MD 21043-3655 - Phone
- (410) 750-9006
- Fax
- (410) 750-0787
- NPI assigned
- Jun 10, 2008
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 5501013196 | MI | Primary |
Addresses
Primary practice location
3290 N Ridge Rd
Suite 290
Ellicott City, MD 21043-3655
Mailing address
3290 N Ridge Rd
Suite 290
Ellicott City, MD 21043-3655
Phone (410) 750-9006
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 5501013196 | MI | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1213056000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1213056000000",
"number": "1174783575",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3290 N RIDGE RD",
"address_2": "SUITE 290",
"city": "ELLICOTT CITY",
"state": "MD",
"postal_code": "210433655",
"telephone_number": "410-750-9006",
"fax_number": "410-750-0787"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3290 N RIDGE RD",
"address_2": "SUITE 290",
"city": "ELLICOTT CITY",
"state": "MD",
"postal_code": "210433655",
"telephone_number": "410-750-9006",
"fax_number": "410-750-0787"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DE LEON",
"first_name": "LEXMOR",
"middle_name": "YU",
"name_prefix": "Mr.",
"credential": "PT",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2008-06-10",
"last_updated": "2008-06-10",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "MI",
"license": "5501013196",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Ellicott City, MD
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 10, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.