Provider Demographics
NPI:1609192269
Name:CALICO, LESLIE L (PT, DPT)
Entity Type:Individual
Prefix:
First Name:LESLIE
Middle Name:L
Last Name:CALICO
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:LESLIE
Other - Middle Name:L
Other - Last Name:ROYSE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:2700 GREENUP AVE
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:KY
Mailing Address - Zip Code:41101-1953
Mailing Address - Country:US
Mailing Address - Phone:606-324-0540
Mailing Address - Fax:606-324-0616
Practice Address - Street 1:2700 GREENUP AVE
Practice Address - Street 2:
Practice Address - City:ASHLAND
Practice Address - State:KY
Practice Address - Zip Code:41101-1953
Practice Address - Country:US
Practice Address - Phone:606-324-0540
Practice Address - Fax:606-324-0616
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-07
Last Update Date:2018-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist