MEDICARE: LESLIE M. MEAD 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
1	225100000X	Physical Therapist	PT021460	PA

General Provider Information

NPI Number	:	1629365150
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LESLIE M. MEAD DPT

Provider Business Mailing Address
First Line	:	15673 MAILLARD RD
Second Line	:
City	:	GUYS MILLS
State	:	PA
Zip	:	16327-2047
Country	:	US
Telephone Number	:	814-573-3665
Fax Number	:

Provider Business Practice Location Address
First Line	:	455 CHESTNUT ST
Second Line	:
City	:	MEADVILLE
State	:	PA
Zip	:	16335-4404
Country	:	US
Telephone Number	:	814-547-5610
Fax Number	:

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

Provider Enumeration Date	:	07/05/2011
Last Update Date	:	01/21/2025

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