Healthcare Provider Details

I. General information

NPI: 1689803850
Provider Name (Legal Business Name): LESLIE ROSE BRANT DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/09/2009
Last Update Date: 06/12/2024
Certification Date: 06/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

85 PAINE ST SE STE B
BONDURANT IA
50035-1154
US

IV. Provider business mailing address

85 PAINE ST SE STE B
BONDURANT IA
50035-1154
US

V. Phone/Fax

Practice location:
  • Phone: 515-528-2326
  • Fax: 515-528-2327
Mailing address:
  • Phone: 515-528-2326
  • Fax: 515-528-2327

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number004437
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: