Provider Demographics
NPI:1215349519
Name:RASOULIAN, LEEDA (PT, DPT)
Entity type:Individual
Prefix:
First Name:LEEDA
Middle Name:
Last Name:RASOULIAN
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3508 FAR WEST BLVD
Mailing Address - Street 2:SUITE 240
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78731-2281
Mailing Address - Country:US
Mailing Address - Phone:512-832-9411
Mailing Address - Fax:512-832-9401
Practice Address - Street 1:3508 FAR WEST BLVD
Practice Address - Street 2:SUITE 240
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78731-2281
Practice Address - Country:US
Practice Address - Phone:512-832-9411
Practice Address - Fax:512-832-9401
Is Sole Proprietor?:No
Enumeration Date:2014-05-21
Last Update Date:2014-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX12467982251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic