Healthcare Provider Details

I. General information

NPI: 1922607068
Provider Name (Legal Business Name): LESLIE BOROUGH DUNLAP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/20/2020
Last Update Date: 10/20/2020
Certification Date: 10/20/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4881 KINGS RIDGE BLVD
BOULDER CO
80301-5435
US

IV. Provider business mailing address

4881 KINGS RIDGE BLVD
BOULDER CO
80301-5435
US

V. Phone/Fax

Practice location:
  • Phone: 303-501-6778
  • Fax:
Mailing address:
  • Phone: 303-501-6778
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: