Provider Demographics
NPI:1467654707
Name:LESLIE, TODD A (MPT)
Entity Type:Individual
Prefix:
First Name:TODD
Middle Name:A
Last Name:LESLIE
Suffix:
Gender:M
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:985 BROADWAY
Mailing Address - Street 2:SUITE E
Mailing Address - City:CHULA VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:91911-1779
Mailing Address - Country:US
Mailing Address - Phone:619-585-0977
Mailing Address - Fax:619-585-1013
Practice Address - Street 1:985 BROADWAY
Practice Address - Street 2:SUITE E
Practice Address - City:CHULA VISTA
Practice Address - State:CA
Practice Address - Zip Code:91911-1779
Practice Address - Country:US
Practice Address - Phone:619-585-0977
Practice Address - Fax:619-585-1013
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-31
Last Update Date:2014-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA27486225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist