Provider Demographics
NPI:1659350262
Name:OGLESBY, LESLIE KAY (PT)
Entity Type:Individual
Prefix:MRS
First Name:LESLIE
Middle Name:KAY
Last Name:OGLESBY
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:LESLIE
Other - Middle Name:KAY
Other - Last Name:OGLESBY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PT
Mailing Address - Street 1:1330 BOILING SPRINGS RD
Mailing Address - Street 2:SUITE B
Mailing Address - City:SPARTANBURG
Mailing Address - State:SC
Mailing Address - Zip Code:29303-4201
Mailing Address - Country:US
Mailing Address - Phone:864-582-0019
Mailing Address - Fax:864-582-2160
Practice Address - Street 1:1330 BOILING SPRINGS RD
Practice Address - Street 2:SUITE B
Practice Address - City:SPARTANBURG
Practice Address - State:SC
Practice Address - Zip Code:29303-4201
Practice Address - Country:US
Practice Address - Phone:864-582-0019
Practice Address - Fax:864-582-2160
Is Sole Proprietor?:No
Enumeration Date:2006-01-11
Last Update Date:2007-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC1097225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC1097OtherSTATE LICENSE NUMBER