Provider Demographics
NPI:1639635048
Name:LESLEY, CAITLIN ROSE (DPT)
Entity Type:Individual
Prefix:
First Name:CAITLIN
Middle Name:ROSE
Last Name:LESLEY
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 1:4636 WHITECHAPEL LN
Mailing Address - Street 2:
Mailing Address - City:BELDEN
Mailing Address - State:MS
Mailing Address - Zip Code:38826-8727
Mailing Address - Country:US
Mailing Address - Phone:662-397-5838
Mailing Address - Fax:
Practice Address - Street 1:306 HOSPITAL DR
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:MS
Practice Address - Zip Code:39705-1935
Practice Address - Country:US
Practice Address - Phone:662-397-5838
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-11
Last Update Date:2019-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS6048225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist