Provider Demographics
NPI:1659458461
Name:SKAROSI, LESLEY C (MPT)
Entity Type:Individual
Prefix:
First Name:LESLEY
Middle Name:C
Last Name:SKAROSI
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:LESLEY
Other - Middle Name:C
Other - Last Name:BOYD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MPT
Mailing Address - Street 1:703 SAINT MARYS DR
Mailing Address - Street 2:
Mailing Address - City:ANACORTES
Mailing Address - State:WA
Mailing Address - Zip Code:98221-3651
Mailing Address - Country:US
Mailing Address - Phone:360-293-2495
Mailing Address - Fax:
Practice Address - Street 1:275 SE CABOT DR
Practice Address - Street 2:
Practice Address - City:OAK HARBOR
Practice Address - State:WA
Practice Address - Zip Code:98277-3715
Practice Address - Country:US
Practice Address - Phone:360-279-1445
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT00008331225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0143082OtherDEPT. LABOR & INDUSTRIES
WA8895SKOtherREGENCE
WA8334922Medicaid
WAP25226Medicare UPIN
WAAB19357Medicare ID - Type Unspecified