Provider Demographics
NPI:1437858016
Name:GLENN, LESLIE H (MT)
Entity Type:Individual
Prefix:
First Name:LESLIE
Middle Name:H
Last Name:GLENN
Suffix:
Gender:F
Credentials:MT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5606 JEFFERSON HWY
Mailing Address - Street 2:
Mailing Address - City:HARAHAN
Mailing Address - State:LA
Mailing Address - Zip Code:70123-5111
Mailing Address - Country:US
Mailing Address - Phone:504-723-0254
Mailing Address - Fax:504-734-8869
Practice Address - Street 1:5606 JEFFERSON HWY
Practice Address - Street 2:
Practice Address - City:HARAHAN
Practice Address - State:LA
Practice Address - Zip Code:70123-5111
Practice Address - Country:US
Practice Address - Phone:504-723-0254
Practice Address - Fax:504-734-8869
Is Sole Proprietor?:No
Enumeration Date:2023-03-02
Last Update Date:2023-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA2658225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist