Healthcare Provider Details

I. General information

NPI: 1447400973
Provider Name (Legal Business Name): LESLIE GOOLEY CERT. REFLEXOLOGIST
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/20/2008
Last Update Date: 09/20/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1121 QUINDARO BLVD
KANSAS CITY KS
66104-5331
US

IV. Provider business mailing address

643 FREEMAN CT
KANSAS CITY KS
66101-2254
US

V. Phone/Fax

Practice location:
  • Phone: 913-375-2503
  • Fax: 913-371-0493
Mailing address:
  • Phone: 913-375-2503
  • Fax: 913-371-0493

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code173C00000X
TaxonomyReflexologist
License NumberCERT. #PS-000289
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: