Provider Demographics
NPI:1992947477
Name:GOSSET, LEON CHARLES (LMT)
Entity type:Individual
Prefix:
First Name:LEON
Middle Name:CHARLES
Last Name:GOSSET
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5704 EVERS RD
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78238-1717
Mailing Address - Country:US
Mailing Address - Phone:210-684-6563
Mailing Address - Fax:210-509-4445
Practice Address - Street 1:5704 EVERS RD
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78238-1717
Practice Address - Country:US
Practice Address - Phone:210-684-6563
Practice Address - Fax:210-509-4445
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-31
Last Update Date:2009-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXMT006645225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist