MEDICARE: LESLIE MARIE HOMOL PT, 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	P21395	NC
2	225100000X	Physical Therapist	10840	SC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	P21395	OTHER	NC	PT
2	28677	OTHER	MD	PHYSICAL THERAPY LICENSE
3	10840	OTHER	SC	PHYSICAL THERAPY LICENSE

General Provider Information

NPI Number	:	1689344038
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LESLIE MARIE HOMOL PT, DPT

Provider Business Mailing Address
First Line	:	2961 LEGACY RIDGE LN
Second Line	:
City	:	CATAWBA
State	:	NC
Zip	:	28609-9547
Country	:	US
Telephone Number	:	440-596-0469
Fax Number	:

Provider Business Practice Location Address
First Line	:	7482 WATERSIDE CROSSING BLVD
Second Line	:
City	:	DENVER
State	:	NC
Zip	:	28037-3005
Country	:	US
Telephone Number	:	410-579-8999
Fax Number	:

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

Provider Enumeration Date	:	09/16/2021
Last Update Date	:	03/02/2026

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