Provider Demographics
NPI:1578668034
Name:DUININK, LESLIE J (LAT, ATC)
Entity Type:Individual
Prefix:
First Name:LESLIE
Middle Name:J
Last Name:DUININK
Suffix:
Gender:F
Credentials:LAT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:812 UNIVERSITY ST
Mailing Address - Street 2:CAMPUS BOX 6600
Mailing Address - City:PELLA
Mailing Address - State:IA
Mailing Address - Zip Code:50219-1902
Mailing Address - Country:US
Mailing Address - Phone:641-628-7643
Mailing Address - Fax:641-628-5356
Practice Address - Street 1:812 UNIVERSITY ST
Practice Address - Street 2:CAMPUS BOX 6600
Practice Address - City:PELLA
Practice Address - State:IA
Practice Address - Zip Code:50219-1902
Practice Address - Country:US
Practice Address - Phone:641-628-7643
Practice Address - Fax:641-628-5356
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA001982255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer