MEDICARE: DR. LESLIE ANNE MCDONALD 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	4269	CO

General Provider Information

NPI Number	:	1811231368
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LESLIE ANNE MCDONALD DPT

Provider Business Mailing Address
First Line	:	9540 LIZARD ROCK TRL
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80924-2901
Country	:	US
Telephone Number	:	719-599-8594
Fax Number	:

Provider Business Practice Location Address
First Line	:	9540 LIZARD ROCK TRL
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80924-2901
Country	:	US
Telephone Number	:	719-599-8594
Fax Number	:

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

Provider Enumeration Date	:	11/22/2012
Last Update Date	:	11/22/2012

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