Provider Demographics
NPI:1467649046
Name:JOHNSON, LESLIE LYNELLE (PT)
Entity Type:Individual
Prefix:MRS
First Name:LESLIE
Middle Name:LYNELLE
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MS
Other - First Name:LESLIE
Other - Middle Name:LYNELLE
Other - Last Name:DABERKOW
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 11009
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64119-0009
Mailing Address - Country:US
Mailing Address - Phone:816-414-5808
Mailing Address - Fax:816-414-5810
Practice Address - Street 1:8121 E HIGHWAY 69
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64119-3186
Practice Address - Country:US
Practice Address - Phone:816-414-5808
Practice Address - Fax:816-414-5810
Is Sole Proprietor?:No
Enumeration Date:2007-09-27
Last Update Date:2007-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR1186225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist