Provider Demographics
NPI:1225326101
Name:LESLEY, ELIZABETH DEE (DPT)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:DEE
Last Name:LESLEY
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3045 KATE BOND RD STE 600
Mailing Address - Street 2:
Mailing Address - City:BARTLETT
Mailing Address - State:TN
Mailing Address - Zip Code:38133-4004
Mailing Address - Country:US
Mailing Address - Phone:901-937-3200
Mailing Address - Fax:901-383-1738
Practice Address - Street 1:3045 KATE BOND RD STE 600
Practice Address - Street 2:
Practice Address - City:BARTLETT
Practice Address - State:TN
Practice Address - Zip Code:38133-4004
Practice Address - Country:US
Practice Address - Phone:901-937-3200
Practice Address - Fax:901-383-1738
Is Sole Proprietor?:No
Enumeration Date:2011-07-13
Last Update Date:2022-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA08133R225100000X
TN9023225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1174173Medicaid
LA1174173Medicaid