Provider Demographics
NPI:1194600957
Name:BOMBASSARO, LEAH DANIELLE (PT, DPT)
Entity type:Individual
Prefix:
First Name:LEAH
Middle Name:DANIELLE
Last Name:BOMBASSARO
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3771 LITTLE CREEK DR
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33905-6406
Mailing Address - Country:US
Mailing Address - Phone:239-223-9562
Mailing Address - Fax:
Practice Address - Street 1:12820 KENWOOD LN STE 5
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33907-5617
Practice Address - Country:US
Practice Address - Phone:239-690-6768
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-08-09
Last Update Date:2025-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT435132251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics