Provider Demographics
NPI:1437277811
Name:LESLIE, SARA ANN (PTA)
Entity Type:Individual
Prefix:
First Name:SARA
Middle Name:ANN
Last Name:LESLIE
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1618 LARCH ST.
Mailing Address - Street 2:
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44301
Mailing Address - Country:US
Mailing Address - Phone:330-773-8040
Mailing Address - Fax:
Practice Address - Street 1:200 WYANT RD
Practice Address - Street 2:
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44313-4228
Practice Address - Country:US
Practice Address - Phone:330-836-7953
Practice Address - Fax:330-864-4526
Is Sole Proprietor?:No
Enumeration Date:2007-03-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPTA 05293225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant