Provider Demographics
NPI:1275780488
Name:STYADI, LESLIE TONY (PT)
Entity Type:Individual
Prefix:
First Name:LESLIE
Middle Name:TONY
Last Name:STYADI
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:799 TURQUOISE AVE
Mailing Address - Street 2:
Mailing Address - City:VENTURA
Mailing Address - State:CA
Mailing Address - Zip Code:93004-4045
Mailing Address - Country:US
Mailing Address - Phone:805-338-6912
Mailing Address - Fax:805-659-2676
Practice Address - Street 1:799 TURQUOISE AVE
Practice Address - Street 2:
Practice Address - City:VENTURA
Practice Address - State:CA
Practice Address - Zip Code:93004-4045
Practice Address - Country:US
Practice Address - Phone:805-338-6912
Practice Address - Fax:805-659-2676
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-19
Last Update Date:2008-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA21153225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist