Provider Demographics
NPI:1285847749
Name:HODAM, LESLEIGH (PTA)
Entity Type:Individual
Prefix:
First Name:LESLEIGH
Middle Name:
Last Name:HODAM
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3141 SW CREST
Mailing Address - Street 2:
Mailing Address - City:TOPEKA
Mailing Address - State:KS
Mailing Address - Zip Code:66614
Mailing Address - Country:US
Mailing Address - Phone:785-969-7313
Mailing Address - Fax:
Practice Address - Street 1:1610 SW 37TH ST
Practice Address - Street 2:
Practice Address - City:TOPEKA
Practice Address - State:KS
Practice Address - Zip Code:66609
Practice Address - Country:US
Practice Address - Phone:785-267-2960
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1401866225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant