Provider Demographics
NPI:1962774554
Name:LEODONES, ROWENA MERCADO (PT)
Entity type:Individual
Prefix:MRS
First Name:ROWENA
Middle Name:MERCADO
Last Name:LEODONES
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MS
Other - First Name:ROWENA
Other - Middle Name:FALLE
Other - Last Name:MERCADO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:1917 VALE DR
Mailing Address - Street 2:
Mailing Address - City:CLERMONT
Mailing Address - State:FL
Mailing Address - Zip Code:34711-5179
Mailing Address - Country:US
Mailing Address - Phone:407-712-5631
Mailing Address - Fax:407-777-9805
Practice Address - Street 1:15204 W COLONIAL DR
Practice Address - Street 2:
Practice Address - City:WINTER GARDEN
Practice Address - State:FL
Practice Address - Zip Code:34787-6042
Practice Address - Country:US
Practice Address - Phone:407-877-2394
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-30
Last Update Date:2012-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT26847225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist