Provider Demographics
NPI:1447400973
Name:GOOLEY, LESLIE (CERT REFLEXOLOGIST)
Entity Type:Individual
Prefix:MR
First Name:LESLIE
Middle Name:
Last Name:GOOLEY
Suffix:
Gender:M
Credentials:CERT REFLEXOLOGIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:643 FREEMAN CT
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:KS
Mailing Address - Zip Code:66101-2254
Mailing Address - Country:US
Mailing Address - Phone:913-375-2503
Mailing Address - Fax:913-371-0493
Practice Address - Street 1:1121 QUINDARO BLVD
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:KS
Practice Address - Zip Code:66104-5331
Practice Address - Country:US
Practice Address - Phone:913-375-2503
Practice Address - Fax:913-371-0493
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-20
Last Update Date:2008-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COCERT. #PS-000289173C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes173C00000XOther Service ProvidersReflexologist