Provider Demographics
NPI:1346559655
Name:ROY, LESLIE KIM (PT)
Entity Type:Individual
Prefix:MRS
First Name:LESLIE
Middle Name:KIM
Last Name:ROY
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6101 N RIM RD
Mailing Address - Street 2:
Mailing Address - City:LIVERMORE
Mailing Address - State:CO
Mailing Address - Zip Code:80536-7686
Mailing Address - Country:US
Mailing Address - Phone:970-744-8238
Mailing Address - Fax:
Practice Address - Street 1:1160 E 130TH AVE
Practice Address - Street 2:UNIT B
Practice Address - City:THORNTON
Practice Address - State:CO
Practice Address - Zip Code:80241-3933
Practice Address - Country:US
Practice Address - Phone:720-982-3783
Practice Address - Fax:888-313-1418
Is Sole Proprietor?:No
Enumeration Date:2010-10-04
Last Update Date:2010-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPTL-13842251G0304X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251G0304XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGeriatrics