Provider Demographics
NPI:1699548859
Name:LEBLANC, PEYTON OZ (DPT)
Entity type:Individual
Prefix:
First Name:PEYTON
Middle Name:OZ
Last Name:LEBLANC
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1151 BARATARIA BLVD STE 4300
Mailing Address - Street 2:
Mailing Address - City:MARRERO
Mailing Address - State:LA
Mailing Address - Zip Code:70072-3084
Mailing Address - Country:US
Mailing Address - Phone:504-934-8140
Mailing Address - Fax:504-934-8044
Practice Address - Street 1:1151 BARATARIA BLVD STE 4300
Practice Address - Street 2:
Practice Address - City:MARRERO
Practice Address - State:LA
Practice Address - Zip Code:70072-3084
Practice Address - Country:US
Practice Address - Phone:504-934-8140
Practice Address - Fax:504-934-8044
Is Sole Proprietor?:No
Enumeration Date:2023-10-31
Last Update Date:2024-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD29796225100000X
LA11657225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist