Healthcare Provider Details

I. General information

NPI: 1801145115
Provider Name (Legal Business Name): LESLIE RICHARDS PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/31/2012
Last Update Date: 10/05/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 N COLLEGIATE DR SUITE 550
PARIS TX
75460-1494
US

IV. Provider business mailing address

677 ALA MOANA BLVD 725
HONOLULU HI
96813-5419
US

V. Phone/Fax

Practice location:
  • Phone: 903-784-3173
  • Fax: 903-784-7912
Mailing address:
  • Phone: 808-734-0010
  • Fax: 808-734-0013

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number1221576
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: