Provider Demographics
NPI:1497237739
Name:CAGLE, LESLIE CLAIRE (PT, DPT)
Entity Type:Individual
Prefix:
First Name:LESLIE CLAIRE
Middle Name:
Last Name:CAGLE
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13358 S 5600 W
Mailing Address - Street 2:
Mailing Address - City:HERRIMAN
Mailing Address - State:UT
Mailing Address - Zip Code:84096-6789
Mailing Address - Country:US
Mailing Address - Phone:801-302-7232
Mailing Address - Fax:801-302-7237
Practice Address - Street 1:13358 S 5600 W
Practice Address - Street 2:
Practice Address - City:HERRIMAN
Practice Address - State:UT
Practice Address - Zip Code:84096-6789
Practice Address - Country:US
Practice Address - Phone:801-302-7232
Practice Address - Fax:801-302-7237
Is Sole Proprietor?:No
Enumeration Date:2018-09-04
Last Update Date:2021-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT10826877-2401225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist