MEDICARE: MRS. LESLEY DENISE RICHARDT R.P.T.A.

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	225200000X	Physical Therapy Assistant	946	OK

General Provider Information

NPI Number	:	1992915821
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. LESLEY DENISE RICHARDT R.P.T.A.

Provider Business Mailing Address
First Line	:	5418 REDBUD DR
Second Line	:
City	:	SAND SPRINGS
State	:	OK
Zip	:	74063-3265
Country	:	US
Telephone Number	:	918-520-2756
Fax Number	:	918-419-2086

Provider Business Practice Location Address
First Line	:	5418 REDBUD DR
Second Line	:
City	:	SAND SPRINGS
State	:	OK
Zip	:	74063-3265
Country	:	US
Telephone Number	:	918-520-2756
Fax Number	:	918-419-2086

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

Provider Enumeration Date	:	05/22/2007
Last Update Date	:	07/08/2007

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