Provider Demographics
NPI:1558457226
Name:WHITE, LESLIE LINCK (PT)
Entity Type:Individual
Prefix:
First Name:LESLIE
Middle Name:LINCK
Last Name:WHITE
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:LESLIE
Other - Middle Name:ANN
Other - Last Name:WHITE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:1779 WOODSIDE RD
Mailing Address - Street 2:SUITE #102
Mailing Address - City:REDWOOD CITY
Mailing Address - State:CA
Mailing Address - Zip Code:94061-3461
Mailing Address - Country:US
Mailing Address - Phone:650-780-9700
Mailing Address - Fax:
Practice Address - Street 1:1779 WOODSIDE RD
Practice Address - Street 2:SUITE #102
Practice Address - City:REDWOOD CITY
Practice Address - State:CA
Practice Address - Zip Code:94061-3461
Practice Address - Country:US
Practice Address - Phone:650-780-9700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2007-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT22844225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist