Provider Demographics
NPI:1629205091
Name:MARSICANO, LESLIE
Entity Type:Individual
Prefix:
First Name:LESLIE
Middle Name:
Last Name:MARSICANO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8800 GRAND OAK CIR
Mailing Address - Street 2:SUITE 450
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33637-2006
Mailing Address - Country:US
Mailing Address - Phone:813-558-6548
Mailing Address - Fax:
Practice Address - Street 1:5612 26TH ST W
Practice Address - Street 2:
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34207-3515
Practice Address - Country:US
Practice Address - Phone:941-751-6532
Practice Address - Fax:941-751-6932
Is Sole Proprietor?:No
Enumeration Date:2009-06-12
Last Update Date:2009-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPTA 0001237225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant