MEDICARE: MRS. LESLIE G CLODFELTER M.S., P.T.

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	225100000X	Physical Therapist	05003607A	IN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1144398033
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. LESLIE G CLODFELTER M.S., P.T.

Provider Business Mailing Address
First Line	:	600 OAKMONT LN
Second Line	:	STE 600C
City	:	WESTMONT
State	:	IL
Zip	:	60559-5548
Country	:	US
Telephone Number	:	630-575-1980
Fax Number	:

Provider Business Practice Location Address
First Line	:	1003 MILL POND LN STE C
Second Line	:
City	:	GREENCASTLE
State	:	IN
Zip	:	46135-2609
Country	:	US
Telephone Number	:	765-653-8494
Fax Number	:

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

Provider Enumeration Date	:	12/01/2006
Last Update Date	:	02/18/2020

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