Provider Demographics
NPI:1336462605
Name:CARTER, LESLIE FORT
Entity Type:Individual
Prefix:MRS
First Name:LESLIE
Middle Name:FORT
Last Name:CARTER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:417 COTTONWOOD LN
Mailing Address - Street 2:
Mailing Address - City:HOLLY SPRINGS
Mailing Address - State:NC
Mailing Address - Zip Code:27540-9178
Mailing Address - Country:US
Mailing Address - Phone:919-285-3147
Mailing Address - Fax:
Practice Address - Street 1:7829 PERCUSSION DR
Practice Address - Street 2:
Practice Address - City:APEX
Practice Address - State:NC
Practice Address - Zip Code:27539-3611
Practice Address - Country:US
Practice Address - Phone:919-363-7585
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-03-01
Last Update Date:2010-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist