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NPI Code Detail

MEDICARE: LESLIE OLSEN LPT

MEDICARE: LESLIE OLSEN LPT
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 Therapist1039865TX

General Provider Information

NPI Number : 1427131549
Entity Type Code : Individual
Provider Name (Legal Business Name) : LESLIE OLSEN LPT
Provider Business Mailing Address
First Line : 4423 SHADOWDALE DR
Second Line :
City : HOUSTON
State : TX
Zip : 77041-8718
Country : US
Telephone Number : 713-466-6872
Fax Number : 713-466-9547
Provider Business Practice Location Address
First Line : 4423 SHADOWDALE DR
Second Line :
City : HOUSTON
State : TX
Zip : 77041-8718
Country : US
Telephone Number : 713-466-6872
Fax Number : 713-466-9547
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/23/2006
Last Update Date : 07/08/2007

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