Provider Demographics
NPI:1568623239
Name:HOUSTON, LESLI KAY (PTA)
Entity Type:Individual
Prefix:MS
First Name:LESLI
Middle Name:KAY
Last Name:HOUSTON
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1250 S CAWSTON AVE
Mailing Address - Street 2:APT D7
Mailing Address - City:HEMET
Mailing Address - State:CA
Mailing Address - Zip Code:92545-7900
Mailing Address - Country:US
Mailing Address - Phone:951-925-8844
Mailing Address - Fax:951-925-8844
Practice Address - Street 1:1250 S CAWSTON AVE
Practice Address - Street 2:APT D7
Practice Address - City:HEMET
Practice Address - State:CA
Practice Address - Zip Code:92545-7900
Practice Address - Country:US
Practice Address - Phone:951-925-8844
Practice Address - Fax:951-925-8844
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-24
Last Update Date:2008-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAT 2436225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant