Provider Demographics
NPI:1568914349
Name:JAMISON, LESLIE ROBERGE (DPT)
Entity Type:Individual
Prefix:
First Name:LESLIE
Middle Name:ROBERGE
Last Name:JAMISON
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6336 BUCHANAN ST
Mailing Address - Street 2:
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80525-5810
Mailing Address - Country:US
Mailing Address - Phone:970-682-4460
Mailing Address - Fax:
Practice Address - Street 1:375 E HORSETOOTH RD STE 104
Practice Address - Street 2:
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80525-3155
Practice Address - Country:US
Practice Address - Phone:970-286-2868
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-10-27
Last Update Date:2021-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEJ10003607225100000X
MD26271225100000X
COPTL.0016296225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist