Provider Demographics
NPI:1538509377
Name:ROPPOLO, LESLI ERMEL (PT)
Entity Type:Individual
Prefix:MRS
First Name:LESLI
Middle Name:ERMEL
Last Name:ROPPOLO
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4347 W NORTHWEST HWY STE 180
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75220-3863
Mailing Address - Country:US
Mailing Address - Phone:214-654-0947
Mailing Address - Fax:214-654-0956
Practice Address - Street 1:4347 W NORTHWEST HWY STE 180
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75220-3863
Practice Address - Country:US
Practice Address - Phone:214-654-0947
Practice Address - Fax:214-654-0956
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-25
Last Update Date:2013-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1158286225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist