MEDICARE: LESLEY SCHMITZ D.O. AND ASSOCIATES

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	204D00000X	Neuromusculoskeletal Medicine & OMM Physician	L7877	TX

General Provider Information

NPI Number	:	1013384775
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LESLEY SCHMITZ D.O. AND ASSOCIATES

Provider Business Mailing Address
First Line	:	4545 BELLAIRE DR S
Second Line	:	SUITE 200
City	:	FORT WORTH
State	:	TX
Zip	:	76109-1889
Country	:	US
Telephone Number	:	817-240-2343
Fax Number	:	817-945-1038

Provider Business Practice Location Address
First Line	:	4545 BELLAIRE DR S
Second Line	:	SUITE 200
City	:	FORT WORTH
State	:	TX
Zip	:	76109-1889
Country	:	US
Telephone Number	:	817-240-2343
Fax Number	:	817-945-1038

Authorized Official
Title or Position	:	PRESIDENT/OWNER
Name	:	DR. LESLEY SCHMITZ
Credential	:	DO
Telephone Number	:	214-762-5751

Provider Enumeration Date	:	08/28/2015
Last Update Date	:	08/08/2016

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