Healthcare Provider Details

I. General information

NPI: 1235079948
Provider Name (Legal Business Name): LESLI D FUSON PTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/31/2026
Last Update Date: 03/31/2026
Certification Date: 03/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1675 W JEFFERSON ST STE A
SILOAM SPRINGS AR
72761-3001
US

IV. Provider business mailing address

473321 E 730 RD
WESTVILLE OK
74965-5388
US

V. Phone/Fax

Practice location:
  • Phone: 479-524-8028
  • Fax: 479-524-6151
Mailing address:
  • Phone: 479-524-8028
  • Fax: 479-524-6151

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberPTA4183
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: