Provider Demographics
NPI:1114078128
Name:WOOD, LESLIE SMITH (DPT, CSCS)
Entity Type:Individual
Prefix:MRS
First Name:LESLIE
Middle Name:SMITH
Last Name:WOOD
Suffix:
Gender:F
Credentials:DPT, CSCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 720
Mailing Address - Street 2:210 S. MAIN ST.
Mailing Address - City:AMHERST
Mailing Address - State:VA
Mailing Address - Zip Code:24521-0720
Mailing Address - Country:US
Mailing Address - Phone:434-946-1314
Mailing Address - Fax:434-946-1083
Practice Address - Street 1:210 S. MAIN ST.
Practice Address - Street 2:
Practice Address - City:AMHERST
Practice Address - State:VA
Practice Address - Zip Code:24521-0720
Practice Address - Country:US
Practice Address - Phone:434-946-1314
Practice Address - Fax:434-946-1083
Is Sole Proprietor?:No
Enumeration Date:2007-01-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305203874225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist