Brady Latham Leissner

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

1360214 Issued in TX

Practice address

1014 N Nolan River Rd Unit B
Cleburne, TX 76033-7936

Phone

(817) 406-1408

NPI assigned

May 19, 2022

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1652918400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1669680000000",
    "number": "1376280347",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2051 MAYFIELD PKWY APT 1221",
            "city": "CLEBURNE",
            "state": "TX",
            "postal_code": "760334226",
            "telephone_number": "325-493-8990"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1014 N NOLAN RIVER RD UNIT B",
            "city": "CLEBURNE",
            "state": "TX",
            "postal_code": "760337936",
            "telephone_number": "817-406-1408"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LEISSNER",
        "first_name": "BRADY",
        "middle_name": "LATHAM",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2022-05-19",
        "last_updated": "2022-11-29",
        "certification_date": "2022-11-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "261QP2000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Physical Therapy",
            "state": "TX",
            "license": "1360214",
            "primary": false
        },
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "TX",
            "license": "1360214",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "https://realperformancept.com/",
            "affiliation": "N",
            "address_1": "1014 N Nolan River Rd Unit B",
            "city": "Cleburne",
            "state": "TX",
            "country_code": "US",
            "postal_code": "760337936",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

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• Physical Therapist in Cleburne, TX
• Providers in Cleburne, TX by specialty
• Physical Therapist in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 29, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.