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General NPI Number Information
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NPI Number | 1881462570
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Entity Type | Individual
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Provider Name | SCOTT LESLIE PTA
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Gender | Male
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Dates
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Enumeration Date | 12/13/2023
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Last Update Date | 12/13/2023
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Provider Practice Location Address
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Address Line | 771 CORPORATE DR STE 1020
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City | LEXINGTON
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State | KY
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Zip | 40503-5482
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Country | US
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Telephone | 859-276-5369
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Fax | 859-276-1783
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Provider Business Mailing Address
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Address Line | 771 CORPORATE DR STE 1020
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City | LEXINGTON
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State | KY
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Zip | 40503-5482
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Country | US
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Telephone | 859-276-5369
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Fax | 859-276-1783
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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 | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | A03966
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License Number State | KY
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