MEDICARE: MR. LESLIE GOOLEY CERT. REFLEXOLOGIST

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	173C00000X	Reflexologist	CERT. #PS-000289	CO

General Provider Information

NPI Number	:	1447400973
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. LESLIE GOOLEY CERT. REFLEXOLOGIST

Provider Business Mailing Address
First Line	:	643 FREEMAN CT
Second Line	:
City	:	KANSAS CITY
State	:	KS
Zip	:	66101-2254
Country	:	US
Telephone Number	:	913-375-2503
Fax Number	:	913-371-0493

Provider Business Practice Location Address
First Line	:	1121 QUINDARO BLVD
Second Line	:
City	:	KANSAS CITY
State	:	KS
Zip	:	66104-5331
Country	:	US
Telephone Number	:	913-375-2503
Fax Number	:	913-371-0493

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/20/2008
Last Update Date	:	09/20/2008

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