Provider Demographics
NPI:1548570351
Name:PRIDDY, LESLIE J (LPTA)
Entity Type:Individual
Prefix:
First Name:LESLIE
Middle Name:J
Last Name:PRIDDY
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 1:1603 DARLINGTON ROAD
Mailing Address - Street 2:
Mailing Address - City:BEAVER FALLS
Mailing Address - State:PA
Mailing Address - Zip Code:15010-2553
Mailing Address - Country:US
Mailing Address - Phone:724-622-0725
Mailing Address - Fax:
Practice Address - Street 1:1603 DARLINGTON RD
Practice Address - Street 2:
Practice Address - City:BEAVER FALLS
Practice Address - State:PA
Practice Address - Zip Code:15010-2553
Practice Address - Country:US
Practice Address - Phone:724-622-0725
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-14
Last Update Date:2010-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR8685225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant