Individual provider Active NPI

Toshio Raul Leeper, P.T.

  • Physical Therapist
  • Davis, CA
National Provider Identifier
1689017725
Registry record updated Feb 9, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
PT39939 Issued in CA
Practice address
1460 Drew Ave Ste 200
Davis, CA 95618-4856
Phone
(530) 753-9011
Fax
(530) 753-9021
NPI assigned
Apr 8, 2013
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 9, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X PT39939 CA Primary

Addresses

Primary practice location

1460 Drew Ave Ste 200
Davis, CA 95618-4856

Mailing address

1460 Drew Ave Ste 200
Davis, CA 95618-4856
Phone (530) 753-9011

Other names 1

  • Toshio Raul Sidney-Ando Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20130515000457 CA Practitioner - Physical Therapist in Private Practice 5294972089 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physical Therapist in Private Practice
Education
Other, 2012
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Physical Edge, Inc.Group PAC ID 7214990399, 9 clinicians

Practice addresses (Care Compare)

1460 Drew Ave
Suite 200
Dans, CA 95618-4856
Phone (530) 753-9011

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
39939CAMDMarriage & Family Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Physical Edge Specialty Services Physical Therapist CurrentSince Feb 12, 2023 Accepting new patients
Physical Edge, Inc. Physical Therapist CurrentSince Feb 13, 2023 Accepting new patients
RPM Rebah, Inc Physical Therapist Past Accepting new patients

Locations

1460 Drew Ave
Ste 200
Davis, CA 95618
Phone (530) 753-9011

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1365379200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1675900800000",
    "number": "1689017725",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1460 DREW AVE STE 200",
            "city": "DAVIS",
            "state": "CA",
            "postal_code": "956184856",
            "telephone_number": "530-753-9011",
            "fax_number": "530-753-9021"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1460 DREW AVE STE 200",
            "city": "DAVIS",
            "state": "CA",
            "postal_code": "956184856",
            "telephone_number": "530-753-9011",
            "fax_number": "530-753-9021"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LEEPER",
        "first_name": "TOSHIO",
        "middle_name": "RAUL",
        "credential": "P.T.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2013-04-08",
        "last_updated": "2023-02-09",
        "certification_date": "2023-02-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "CA",
            "license": "PT39939",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "TOSHIO",
            "last_name": "SIDNEY-ANDO",
            "middle_name": "RAUL",
            "credential": "P.T.",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Davis, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 9, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.