Healthcare Provider Details

I. General information

NPI: 1528304698
Provider Name (Legal Business Name): LESLIE JEAN DYKSTRA-ORDANES P.T.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LESLIE JEAN DYKSTRA P.T.

II. Dates (important events)

Enumeration Date: 12/18/2012
Last Update Date: 01/22/2021
Certification Date: 01/22/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5122 KATELLA AVE STE 16
LOS ALAMITOS CA
90720-2838
US

IV. Provider business mailing address

5530 E HANBURY ST
LONG BEACH CA
90808-2005
US

V. Phone/Fax

Practice location:
  • Phone: 562-795-5295
  • Fax:
Mailing address:
  • Phone: 562-682-1884
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT21523
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: