Provider Demographics
NPI:1659829679
Name:FICKERT, LESLIE ANN (PT)
Entity Type:Individual
Prefix:
First Name:LESLIE
Middle Name:ANN
Last Name:FICKERT
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1411 W COUNTY LINE RD
Mailing Address - Street 2:
Mailing Address - City:GREENWOOD
Mailing Address - State:IN
Mailing Address - Zip Code:46142-5249
Mailing Address - Country:US
Mailing Address - Phone:800-486-4449
Mailing Address - Fax:317-886-5027
Practice Address - Street 1:1350 W MAIN ST
Practice Address - Street 2:
Practice Address - City:BERNE
Practice Address - State:IN
Practice Address - Zip Code:46711-1741
Practice Address - Country:US
Practice Address - Phone:260-589-4418
Practice Address - Fax:260-589-4447
Is Sole Proprietor?:No
Enumeration Date:2016-09-19
Last Update Date:2016-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN05011072A225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist