Provider Demographics
NPI:1912080201
Name:LEITZEL, WILLIAM ALFRED (MSPT)
Entity type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:ALFRED
Last Name:LEITZEL
Suffix:
Gender:M
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 W 10TH ST
Mailing Address - Street 2:
Mailing Address - City:MARCUS HOOK
Mailing Address - State:PA
Mailing Address - Zip Code:19061-4513
Mailing Address - Country:US
Mailing Address - Phone:610-859-8850
Mailing Address - Fax:610-859-7876
Practice Address - Street 1:283 SECOND STREET PIKE
Practice Address - Street 2:SUITE145
Practice Address - City:SOUTHAMPTON
Practice Address - State:PA
Practice Address - Zip Code:18966-3823
Practice Address - Country:US
Practice Address - Phone:215-494-2255
Practice Address - Fax:215-434-2258
Is Sole Proprietor?:No
Enumeration Date:2006-10-23
Last Update Date:2010-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT013985L225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1160735OtherKEYSTONE MERCY
PAP0069308OtherMEDICARE RAILROAD
DEP0039457OtherMEDICARE RAILROAD
PA1341106OtherHIGHMARK PABS
PA01884608Medicaid
PA0188460801OtherAMERICHOICE
PA2033765000OtherIBC
PA053889VLZMedicare PIN