Provider Demographics
NPI:1558393926
Name:LESLIE, TRICIA ANN (ATC)
Entity Type:Individual
Prefix:
First Name:TRICIA
Middle Name:ANN
Last Name:LESLIE
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:226 PINE HOLLOW DR
Mailing Address - Street 2:
Mailing Address - City:AIKEN
Mailing Address - State:SC
Mailing Address - Zip Code:29803-9691
Mailing Address - Country:US
Mailing Address - Phone:803-643-0131
Mailing Address - Fax:
Practice Address - Street 1:1706 MAGNOLIA WAY
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30909
Practice Address - Country:US
Practice Address - Phone:706-210-7529
Practice Address - Fax:706-312-7613
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2009-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAAT0005282255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer