Healthcare Provider Details

I. General information

NPI: 1659829679
Provider Name (Legal Business Name): LESLIE ANN FICKERT PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/19/2016
Last Update Date: 09/19/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1350 W MAIN ST
BERNE IN
46711-1741
US

IV. Provider business mailing address

1411 W COUNTY LINE RD
GREENWOOD IN
46142-5249
US

V. Phone/Fax

Practice location:
  • Phone: 260-589-4418
  • Fax: 260-589-4447
Mailing address:
  • Phone: 800-486-4449
  • Fax: 317-886-5027

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number05011072A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: