Provider Demographics
NPI:1124549001
Name:BROSS, LESLIE MARIE (DPT)
Entity Type:Individual
Prefix:
First Name:LESLIE
Middle Name:MARIE
Last Name:BROSS
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:LESLIE
Other - Middle Name:MARIE
Other - Last Name:TARBITT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:3102 RAINBOW DR STE 200
Mailing Address - Street 2:
Mailing Address - City:RAINBOW CITY
Mailing Address - State:AL
Mailing Address - Zip Code:35906-5804
Mailing Address - Country:US
Mailing Address - Phone:256-549-6387
Mailing Address - Fax:256-549-6391
Practice Address - Street 1:3102 RAINBOW DR STE 200
Practice Address - Street 2:
Practice Address - City:RAINBOW CITY
Practice Address - State:AL
Practice Address - Zip Code:35906-5804
Practice Address - Country:US
Practice Address - Phone:256-549-6387
Practice Address - Fax:256-549-6391
Is Sole Proprietor?:No
Enumeration Date:2017-06-30
Last Update Date:2017-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALPTH8434225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist