MEDICARE: LESLIE HUMES PTA

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	225200000X	Physical Therapy Assistant	A1465	MN
2	225200000X	Physical Therapy Assistant	08744	OR
3	225200000X	Physical Therapy Assistant	AT9674	CA

General Provider Information

NPI Number	:	1902184427
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LESLIE HUMES PTA

Provider Business Mailing Address
First Line	:	4981 TORONTO WAY
Second Line	:
City	:	SACRAMENTO
State	:	CA
Zip	:	95820-6238
Country	:	US
Telephone Number	:	218-393-7724
Fax Number	:

Provider Business Practice Location Address
First Line	:	9500 MICRON AVE
Second Line	:	SUITE 106
City	:	SACRAMENTO
State	:	CA
Zip	:	95827-2617
Country	:	US
Telephone Number	:	916-362-7962
Fax Number	:

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

Provider Enumeration Date	:	08/01/2011
Last Update Date	:	08/15/2013

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