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NPI Code Detail

MEDICARE: LESLIE MARIE LESAGE DPT

MEDICARE: LESLIE MARIE LESAGE DPT
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
1225100000XPhysical TherapistPT32986FL

General Provider Information

NPI Number : 1144702135
Entity Type Code : Individual
Provider Name (Legal Business Name) : LESLIE MARIE LESAGE DPT
Provider Business Mailing Address
First Line : 749 BEACH DR
Second Line :
City : DESTIN
State : FL
Zip : 32541-1620
Country : US
Telephone Number : 912-631-3176
Fax Number :
Provider Business Practice Location Address
First Line : 138 SANDESTIN LN
Second Line :
City : DESTIN
State : FL
Zip : 32550-5815
Country : US
Telephone Number : 850-267-2887
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/05/2018
Last Update Date : 09/05/2018

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Directions to “ LESLIE MARIE LESAGE DPT” Practice Location

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