Provider Demographics
NPI:1477977270
Name:CROWE, LESLIE-BRHETTE (LPTA)
Entity Type:Individual
Prefix:
First Name:LESLIE-BRHETTE
Middle Name:
Last Name:CROWE
Suffix:
Gender:F
Credentials:LPTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8113 BLANDSFORD DR
Mailing Address - Street 2:
Mailing Address - City:MANASSAS
Mailing Address - State:VA
Mailing Address - Zip Code:20111-2949
Mailing Address - Country:US
Mailing Address - Phone:703-901-2159
Mailing Address - Fax:
Practice Address - Street 1:9161 LIBERIA AVE
Practice Address - Street 2:
Practice Address - City:MANASSAS
Practice Address - State:VA
Practice Address - Zip Code:20110-1723
Practice Address - Country:US
Practice Address - Phone:571-229-1111
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-02-13
Last Update Date:2014-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2306603603225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant