Provider Demographics
NPI:1467902932
Name:LESEBERG, LEISA CAROL (AAS, RRT)
Entity Type:Individual
Prefix:MS
First Name:LEISA
Middle Name:CAROL
Last Name:LESEBERG
Suffix:
Gender:F
Credentials:AAS, RRT
Other - Prefix:MS
Other - First Name:LEISA
Other - Middle Name:CAROL
Other - Last Name:WOODS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:AAS, RRT
Mailing Address - Street 1:5318 ANTELOPE DR
Mailing Address - Street 2:
Mailing Address - City:BAR NUNN
Mailing Address - State:WY
Mailing Address - Zip Code:82601-9477
Mailing Address - Country:US
Mailing Address - Phone:307-389-3355
Mailing Address - Fax:
Practice Address - Street 1:2360 E PERSHING BLVD
Practice Address - Street 2:
Practice Address - City:CHEYENNE
Practice Address - State:WY
Practice Address - Zip Code:82001-5356
Practice Address - Country:US
Practice Address - Phone:307-778-7344
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-09
Last Update Date:2016-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY47227900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes227900000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, Registered