Provider Demographics
NPI:1366674020
Name:FAZIO, LESLIE (PT DPT)
Entity Type:Individual
Prefix:
First Name:LESLIE
Middle Name:
Last Name:FAZIO
Suffix:
Gender:F
Credentials:PT DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20410 CENTURY BLVD
Mailing Address - Street 2:NRH REGIONAL REHAB - SUITE 215
Mailing Address - City:GERMANTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:20874-1186
Mailing Address - Country:US
Mailing Address - Phone:301-540-8054
Mailing Address - Fax:
Practice Address - Street 1:20410 CENTURY BLVD
Practice Address - Street 2:NRH REGIONAL REHAB - SUITE 215
Practice Address - City:GERMANTOWN
Practice Address - State:MD
Practice Address - Zip Code:20874-1186
Practice Address - Country:US
Practice Address - Phone:301-540-8054
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-08-14
Last Update Date:2009-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist