MEDICARE: MRS. LESLIE KAY OGLESBY PT

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	1097	SC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1097	OTHER	SC	STATE LICENSE NUMBER

General Provider Information

NPI Number	:	1659350262
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. LESLIE KAY OGLESBY PT

Provider Business Mailing Address
First Line	:	1330 BOILING SPRINGS RD
Second Line	:	SUITE B
City	:	SPARTANBURG
State	:	SC
Zip	:	29303-4201
Country	:	US
Telephone Number	:	864-582-0019
Fax Number	:	864-582-2160

Provider Business Practice Location Address
First Line	:	1330 BOILING SPRINGS RD
Second Line	:	SUITE B
City	:	SPARTANBURG
State	:	SC
Zip	:	29303-4201
Country	:	US
Telephone Number	:	864-582-0019
Fax Number	:	864-582-2160

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

Provider Enumeration Date	:	01/11/2006
Last Update Date	:	11/30/2007

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