Provider Demographics
NPI:1407004609
Name:MAGUIRE, LESLEY M (PT)
Entity Type:Individual
Prefix:MS
First Name:LESLEY
Middle Name:M
Last Name:MAGUIRE
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 1:2591 SUNLAND AVE
Mailing Address - Street 2:
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88012-8312
Mailing Address - Country:US
Mailing Address - Phone:575-373-3145
Mailing Address - Fax:
Practice Address - Street 1:SW REGIONAL ED CENTER #10
Practice Address - Street 2:
Practice Address - City:ANIMAS
Practice Address - State:NM
Practice Address - Zip Code:88020
Practice Address - Country:US
Practice Address - Phone:575-555-5555
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-03
Last Update Date:2008-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM2021225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist