Healthcare Provider Details

I. General information

NPI: 1790930931
Provider Name (Legal Business Name): LESLIE WHITE SWIFT DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LESLIE ANN WHITE

II. Dates (important events)

Enumeration Date: 12/01/2008
Last Update Date: 04/26/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

659 S SALISBURY BLVD STE 1B
SALISBURY MD
21801-5458
US

IV. Provider business mailing address

659 S SALISBURY BLVD STE 1B
SALISBURY MD
21801-5458
US

V. Phone/Fax

Practice location:
  • Phone: 410-831-3226
  • Fax: 410-677-0883
Mailing address:
  • Phone: 410-831-3226
  • Fax: 410-677-0883

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberJ1-0003342
License Number StateDE
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number22721
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: