Provider Demographics
NPI:1437441722
Name:LESLIE, KRISTINE (LMT)
Entity Type:Individual
Prefix:MS
First Name:KRISTINE
Middle Name:
Last Name:LESLIE
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2192
Mailing Address - Street 2:
Mailing Address - City:EAGLE
Mailing Address - State:CO
Mailing Address - Zip Code:81631-2192
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:960 CHAMBERS AVE
Practice Address - Street 2:SUITE A202
Practice Address - City:EAGLE
Practice Address - State:CO
Practice Address - Zip Code:81631-0000
Practice Address - Country:US
Practice Address - Phone:970-328-7822
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-05
Last Update Date:2011-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1852225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist