Provider Demographics
NPI:1558446898
Name:PICKETT, LESLIE J (PT)
Entity Type:Individual
Prefix:
First Name:LESLIE
Middle Name:J
Last Name:PICKETT
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:PO BOX 84026
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98124-8426
Mailing Address - Country:US
Mailing Address - Phone:206-320-5510
Mailing Address - Fax:
Practice Address - Street 1:3400 CALIFORNIA AVE SW, STE 100
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98116
Practice Address - Country:US
Practice Address - Phone:206-320-5510
Practice Address - Fax:206-320-5522
Is Sole Proprietor?:No
Enumeration Date:2006-10-26
Last Update Date:2008-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT00006436225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist