Provider Demographics
NPI:1407438088
Name:GRANT, LESLIE (DPT)
Entity Type:Individual
Prefix:
First Name:LESLIE
Middle Name:
Last Name:GRANT
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:309 E OVILLA RD
Mailing Address - Street 2:
Mailing Address - City:RED OAK
Mailing Address - State:TX
Mailing Address - Zip Code:75154-3814
Mailing Address - Country:US
Mailing Address - Phone:469-505-4081
Mailing Address - Fax:
Practice Address - Street 1:309 E OVILLA RD
Practice Address - Street 2:
Practice Address - City:RED OAK
Practice Address - State:TX
Practice Address - Zip Code:75154-3814
Practice Address - Country:US
Practice Address - Phone:469-505-4081
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-23
Last Update Date:2021-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1343723225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist