Provider Demographics
NPI:1093888000
Name:DAVIS, LESLIE P (PT, DPT)
Entity Type:Individual
Prefix:
First Name:LESLIE
Middle Name:P
Last Name:DAVIS
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:LESLIE
Other - Middle Name:PROCTOR
Other - Last Name:RASH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:PO BOX 69030
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21264-9030
Mailing Address - Country:US
Mailing Address - Phone:757-873-2306
Mailing Address - Fax:757-873-2306
Practice Address - Street 1:100 WINTERS ST STE 103
Practice Address - Street 2:
Practice Address - City:WEST POINT
Practice Address - State:VA
Practice Address - Zip Code:23181-9534
Practice Address - Country:US
Practice Address - Phone:804-843-9033
Practice Address - Fax:804-843-9037
Is Sole Proprietor?:No
Enumeration Date:2006-11-16
Last Update Date:2018-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305204768225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAP00395278OtherRAILROAD MEDICARE
VA192965OtherBCBS PHY THERAPY
VA7922915OtherAETNA
VA010355613Medicaid
VAC05954Medicare PIN
VA012486T54Medicare PIN