MEDICARE: MISS LESLEY MAY PINCINCE PT

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	2251G0304X	Geriatric Physical Therapist	007043	CT

General Provider Information

NPI Number	:	1477723716
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS LESLEY MAY PINCINCE PT

Provider Business Mailing Address
First Line	:	330 AMITY RD
Second Line	:
City	:	WOODBRIDGE
State	:	CT
Zip	:	06525-2131
Country	:	US
Telephone Number	:	203-814-4055
Fax Number	:	203-389-5712

Provider Business Practice Location Address
First Line	:	330 AMITY RD
Second Line	:
City	:	WOODBRIDGE
State	:	CT
Zip	:	06525-2131
Country	:	US
Telephone Number	:	203-814-4055
Fax Number	:	203-389-5712

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

Provider Enumeration Date	:	03/03/2008
Last Update Date	:	03/03/2008

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