Provider Demographics
NPI:1336286343
Name:ANDERSON, LESLIE KAREN RANDOLPH (PT)
Entity Type:Individual
Prefix:MS
First Name:LESLIE
Middle Name:KAREN RANDOLPH
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 262
Mailing Address - Street 2:11 RAYMOND JOSEPH LANE
Mailing Address - City:CARIBOU
Mailing Address - State:ME
Mailing Address - Zip Code:04736-2046
Mailing Address - Country:US
Mailing Address - Phone:207-498-1204
Mailing Address - Fax:207-498-1355
Practice Address - Street 1:163 VAN BUREN RD
Practice Address - Street 2:SUITE 1
Practice Address - City:CARIBOU
Practice Address - State:ME
Practice Address - Zip Code:04736-3567
Practice Address - Country:US
Practice Address - Phone:207-498-1204
Practice Address - Fax:207-498-1355
Is Sole Proprietor?:No
Enumeration Date:2007-01-31
Last Update Date:2012-08-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
ME950225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist