MEDICARE: LESLIE K WOLFE LESLIE WOLFE

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	2251X0800X	Orthopedic Physical Therapist	3501	GA

General Provider Information

NPI Number	:	1326372293
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LESLIE K WOLFE LESLIE WOLFE

Provider Business Mailing Address
First Line	:	1144 ZIMMER DR NE
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30306-3321
Country	:	US
Telephone Number	:	404-897-1205
Fax Number	:	404-897-1025

Provider Business Practice Location Address
First Line	:	1144 ZIMMER DR NE
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30306-3321
Country	:	US
Telephone Number	:	404-897-1205
Fax Number	:	404-897-1025

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

Provider Enumeration Date	:	09/25/2009
Last Update Date	:	09/25/2009

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