Healthcare Provider Details

I. General information

NPI: 1669613386
Provider Name (Legal Business Name): LESLIE SAXTON LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/09/2009
Last Update Date: 03/09/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 OLD SUDLOW LAKE RD
NORTH AUGUSTA SC
29841-9283
US

IV. Provider business mailing address

401 W MARTINTOWN RD SUITE 205
NORTH AUGUSTA SC
29841-3194
US

V. Phone/Fax

Practice location:
  • Phone: 803-640-6193
  • Fax: 803-593-6601
Mailing address:
  • Phone: 803-640-6193
  • Fax: 803-593-6601

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172M00000X
TaxonomyMechanotherapist
License Number1956
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: