Provider Demographics
NPI:1326372293
Name:WOLFE, LESLIE K (LESLIE WOLFE)
Entity Type:Individual
Prefix:
First Name:LESLIE
Middle Name:K
Last Name:WOLFE
Suffix:
Gender:F
Credentials:LESLIE WOLFE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1144 ZIMMER DR NE
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30306-3321
Mailing Address - Country:US
Mailing Address - Phone:404-897-1205
Mailing Address - Fax:404-897-1025
Practice Address - Street 1:1144 ZIMMER DR NE
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30306-3321
Practice Address - Country:US
Practice Address - Phone:404-897-1205
Practice Address - Fax:404-897-1025
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-25
Last Update Date:2009-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA35012251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic