Provider Demographics
NPI:1295196822
Name:MOSKAL, LESLIE ERIN (DPT)
Entity Type:Individual
Prefix:
First Name:LESLIE
Middle Name:ERIN
Last Name:MOSKAL
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 1:754 VINTAGE CIR
Mailing Address - Street 2:
Mailing Address - City:DESTIN
Mailing Address - State:FL
Mailing Address - Zip Code:32541-1647
Mailing Address - Country:US
Mailing Address - Phone:850-543-1812
Mailing Address - Fax:
Practice Address - Street 1:164 W HEWETT RD
Practice Address - Street 2:
Practice Address - City:SANTA ROSA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32459-3310
Practice Address - Country:US
Practice Address - Phone:850-278-3821
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-03-09
Last Update Date:2016-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL30946225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist