Provider Demographics
NPI:1568006658
Name:PRESCOTT, LESLIE D (LMT)
Entity Type:Individual
Prefix:
First Name:LESLIE
Middle Name:D
Last Name:PRESCOTT
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 1:566 COUNTRY PLACE DR
Mailing Address - Street 2:
Mailing Address - City:TOBYHANNA
Mailing Address - State:PA
Mailing Address - Zip Code:18466-7943
Mailing Address - Country:US
Mailing Address - Phone:201-638-2058
Mailing Address - Fax:
Practice Address - Street 1:566 COUNTRY PLACE DR
Practice Address - Street 2:
Practice Address - City:TOBYHANNA
Practice Address - State:PA
Practice Address - Zip Code:18466-7943
Practice Address - Country:US
Practice Address - Phone:201-638-2058
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-31
Last Update Date:2019-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY017131225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist