Provider Demographics
NPI:1689767667
Name:MCCARTHY, LESLI K (PT)
Entity Type:Individual
Prefix:
First Name:LESLI
Middle Name:K
Last Name:MCCARTHY
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:LESLI
Other - Middle Name:K
Other - Last Name:CARLSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:8800 W LINCOLN AVE
Mailing Address - Street 2:
Mailing Address - City:WEST ALLIS
Mailing Address - State:WI
Mailing Address - Zip Code:53227-2400
Mailing Address - Country:US
Mailing Address - Phone:414-541-1118
Mailing Address - Fax:414-541-3066
Practice Address - Street 1:8800 W LINCOLN AVE
Practice Address - Street 2:
Practice Address - City:WEST ALLIS
Practice Address - State:WI
Practice Address - Zip Code:53227-2400
Practice Address - Country:US
Practice Address - Phone:414-541-1118
Practice Address - Fax:414-541-3066
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2020-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4769024225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist