Provider Demographics
NPI:1043665607
Name:HEISLER, LESLIE (LMT)
Entity Type:Individual
Prefix:
First Name:LESLIE
Middle Name:
Last Name:HEISLER
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12924 HOUGH RD
Mailing Address - Street 2:
Mailing Address - City:RILEY
Mailing Address - State:MI
Mailing Address - Zip Code:48041-3503
Mailing Address - Country:US
Mailing Address - Phone:586-899-5689
Mailing Address - Fax:
Practice Address - Street 1:12924 HOUGH RD
Practice Address - Street 2:
Practice Address - City:RILEY
Practice Address - State:MI
Practice Address - Zip Code:48041-3503
Practice Address - Country:US
Practice Address - Phone:586-899-5689
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-02
Last Update Date:2020-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI7501000247225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist