Provider Demographics
NPI:1568720431
Name:LESLIE PARKER PHYSICAL THERAPY
Entity Type:Organization
Organization Name:LESLIE PARKER PHYSICAL THERAPY
Other - Org Name:INNER BALANCE PHYSICAL THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:LESLIE
Authorized Official - Middle Name:
Authorized Official - Last Name:PARKER
Authorized Official - Suffix:
Authorized Official - Credentials:MPT, CDT
Authorized Official - Phone:207-439-3839
Mailing Address - Street 1:46 SLATE HILL RD
Mailing Address - Street 2:
Mailing Address - City:ELIOT
Mailing Address - State:ME
Mailing Address - Zip Code:03903-1224
Mailing Address - Country:US
Mailing Address - Phone:207-439-3839
Mailing Address - Fax:207-439-3839
Practice Address - Street 1:46 SLATE HILL RD
Practice Address - Street 2:
Practice Address - City:ELIOT
Practice Address - State:ME
Practice Address - Zip Code:03903-1224
Practice Address - Country:US
Practice Address - Phone:207-439-3839
Practice Address - Fax:207-439-3839
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-30
Last Update Date:2012-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPT3581261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy