Provider Demographics
NPI:1235705419
Name:MCLEISH, ROBERT ADAIR (LPTA)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:ADAIR
Last Name:MCLEISH
Suffix:
Gender:M
Credentials:LPTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2013 ENGLISH AVE
Mailing Address - Street 2:
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23320-2403
Mailing Address - Country:US
Mailing Address - Phone:757-672-1208
Mailing Address - Fax:
Practice Address - Street 1:4225 SHORE DR
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23455-2870
Practice Address - Country:US
Practice Address - Phone:757-460-8868
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-28
Last Update Date:2021-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2306602701225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant