Healthcare Provider Details

I. General information

NPI: 1093888000
Provider Name (Legal Business Name): LESLIE P DAVIS PT, DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LESLIE PROCTOR RASH DPT

II. Dates (important events)

Enumeration Date: 11/16/2006
Last Update Date: 04/16/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 WINTERS ST STE 103
WEST POINT VA
23181-9534
US

IV. Provider business mailing address

PO BOX 69030
BALTIMORE MD
21264-9030
US

V. Phone/Fax

Practice location:
  • Phone: 804-843-9033
  • Fax: 804-843-9037
Mailing address:
  • Phone: 757-873-2306
  • Fax: 757-873-2306

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number2305204768
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: