Provider Demographics
NPI:1164541819
Name:WATSON, LESLIE ANN (RPT)
Entity Type:Individual
Prefix:
First Name:LESLIE
Middle Name:ANN
Last Name:WATSON
Suffix:
Gender:F
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6213 DIAMOND RIDGE PKWY
Mailing Address - Street 2:
Mailing Address - City:CASTLE ROCK
Mailing Address - State:CO
Mailing Address - Zip Code:80108-7519
Mailing Address - Country:US
Mailing Address - Phone:303-810-5176
Mailing Address - Fax:303-693-5828
Practice Address - Street 1:6213 DIAMOND RIDGE PKWY
Practice Address - Street 2:
Practice Address - City:CASTLE ROCK
Practice Address - State:CO
Practice Address - Zip Code:80108-7519
Practice Address - Country:US
Practice Address - Phone:303-810-5176
Practice Address - Fax:303-693-5828
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-27
Last Update Date:2011-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO2076225100000X
NY7606225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO96933828Medicaid