Provider Demographics
NPI:1114550712
Name:STURM, LESLIE ANNE (PTA)
Entity Type:Individual
Prefix:
First Name:LESLIE
Middle Name:ANNE
Last Name:STURM
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 W 13TH ST
Mailing Address - Street 2:
Mailing Address - City:JASPER
Mailing Address - State:IN
Mailing Address - Zip Code:47546-1881
Mailing Address - Country:US
Mailing Address - Phone:812-482-7442
Mailing Address - Fax:812-482-7444
Practice Address - Street 1:600 W 13TH ST
Practice Address - Street 2:
Practice Address - City:JASPER
Practice Address - State:IN
Practice Address - Zip Code:47546-1881
Practice Address - Country:US
Practice Address - Phone:812-482-7442
Practice Address - Fax:812-482-7444
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-21
Last Update Date:2020-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN1407859051207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty