Healthcare Provider Details

I. General information

NPI: 1659696847
Provider Name (Legal Business Name): LESLIE BUTERWORTH L.AC.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/31/2010
Last Update Date: 12/08/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5282 MEDICAL DR STE 140
SAN ANTONIO TX
78229-6072
US

IV. Provider business mailing address

125 ODELL ST
SAN ANTONIO TX
78212-1647
US

V. Phone/Fax

Practice location:
  • Phone: 210-862-8470
  • Fax: 210-878-4297
Mailing address:
  • Phone: 210-862-8470
  • Fax: 210-878-4297

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAC00819
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: