MEDICARE: MRS. LESLEY ELIZABETH FREELING PT

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	2251P0200X	Pediatric Physical Therapist	1453	OR

General Provider Information

NPI Number	:	1134180003
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. LESLEY ELIZABETH FREELING PT

Provider Business Mailing Address
First Line	:	7925 SW 135TH AVE
Second Line	:
City	:	BEAVERTON
State	:	OR
Zip	:	97008-6290
Country	:	US
Telephone Number	:	503-644-1988
Fax Number	:	503-626-3638

Provider Business Practice Location Address
First Line	:	5200 SW MACADAM AVE
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97239-3843
Country	:	US
Telephone Number	:	503-224-1998
Fax Number	:	503-224-5176

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/30/2006
Last Update Date	:	07/08/2007

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