Healthcare Provider Details

I. General information

NPI: 1912083312
Provider Name (Legal Business Name): LESLIE CHESSON WOLFF PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/27/2006
Last Update Date: 03/14/2021
Certification Date: 03/14/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5 DUNDAS CIR STE B
GREENSBORO NC
27407-1638
US

IV. Provider business mailing address

7402 CORNUS CT
SUMMERFIELD NC
27358-9514
US

V. Phone/Fax

Practice location:
  • Phone: 336-294-3338
  • Fax: 336-294-6696
Mailing address:
  • Phone: 336-294-3338
  • Fax: 336-294-6696

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License Number2044
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: