Provider Demographics
NPI:1558706507
Name:HARDY, LESLI KARON (LMT)
Entity Type:Individual
Prefix:MS
First Name:LESLI
Middle Name:KARON
Last Name:HARDY
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11625 SW TEAL BLVD
Mailing Address - Street 2:APT A
Mailing Address - City:BEAVERTON
Mailing Address - State:OR
Mailing Address - Zip Code:97007-8236
Mailing Address - Country:US
Mailing Address - Phone:503-833-2129
Mailing Address - Fax:
Practice Address - Street 1:11625 SW TEAL BLVD
Practice Address - Street 2:APT A
Practice Address - City:BEAVERTON
Practice Address - State:OR
Practice Address - Zip Code:97007-8236
Practice Address - Country:US
Practice Address - Phone:503-833-2129
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-03
Last Update Date:2013-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR15798225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist