Provider Demographics
NPI:1588145171
Name:GEBHARDT, LEA PEYTON (PHD, RDN, LDN)
Entity type:Individual
Prefix:DR
First Name:LEA
Middle Name:PEYTON
Last Name:GEBHARDT
Suffix:
Gender:F
Credentials:PHD, RDN, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4709 AVENUE G
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78751-3120
Mailing Address - Country:US
Mailing Address - Phone:512-788-6794
Mailing Address - Fax:512-519-8768
Practice Address - Street 1:809 W 12TH ST STE E4
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78701-1703
Practice Address - Country:US
Practice Address - Phone:512-765-5947
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-22
Last Update Date:2018-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDT80880133VN1004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133VN1004XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Pediatric