=====================================================
General NPI Number Information
=====================================================
NPI Number | 1477723716
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | LESLEY MAY PINCINCE PT
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/03/2008
-----------------------------------------------------
Last Update Date | 03/03/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 330 AMITY RD
-----------------------------------------------------
City | WOODBRIDGE
-----------------------------------------------------
State | CT
-----------------------------------------------------
Zip | 06525-2131
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 203-814-4055
-----------------------------------------------------
Fax | 203-389-5712
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 330 AMITY RD
-----------------------------------------------------
City | WOODBRIDGE
-----------------------------------------------------
State | CT
-----------------------------------------------------
Zip | 06525-2131
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 203-814-4055
-----------------------------------------------------
Fax | 203-389-5712
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2251G0304X
-----------------------------------------------------
Taxonomy Name | Geriatric Physical Therapist
-----------------------------------------------------
License Number | 007043
-----------------------------------------------------
License Number State | CT
-----------------------------------------------------