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General NPI Number Information
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NPI Number | 1003209958
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Entity Type | Individual
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Provider Name | LESLIE JOHN BABBITT III AT, ATC
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Gender | Male
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Dates
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Enumeration Date | 03/16/2015
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Last Update Date | 03/17/2018
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Provider Practice Location Address
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Address Line | 775 S MAIN ST
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City | CHELSEA
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State | MI
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Zip | 48118-1383
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Country | US
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Telephone | 810-360-3134
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Fax |
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Provider Business Mailing Address
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Address Line | 540 E UNADILLA ST
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City | PINCKNEY
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State | MI
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Zip | 48169-9050
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Country | US
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Telephone | 810-360-3134
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number | 2601001860
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License Number State | MI
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