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NPI Code Detail

MEDICARE: LESLIE HOLMES CORDERO DPT

MEDICARE: LESLIE HOLMES CORDERO 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 Therapist10246NC

General Provider Information

NPI Number : 1174625776
Entity Type Code : Individual
Provider Name (Legal Business Name) : LESLIE HOLMES CORDERO DPT
Provider Business Mailing Address
First Line : 4012 PARK RD STE 200
Second Line :
City : CHARLOTTE
State : NC
Zip : 28209-2378
Country : US
Telephone Number : 919-604-0205
Fax Number :
Provider Business Practice Location Address
First Line : 4012 PARK RD STE 200
Second Line :
City : CHARLOTTE
State : NC
Zip : 28209-2378
Country : US
Telephone Number : 704-332-4834
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/02/2006
Last Update Date : 01/02/2015

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