Provider Demographics
NPI:1700835543
Name:MCPETERS, LESLIE (PTA)
Entity Type:Individual
Prefix:
First Name:LESLIE
Middle Name:
Last Name:MCPETERS
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:843 WAKE FOREST BUSINESS PARK
Mailing Address - Street 2:SUITE 110
Mailing Address - City:WAKE FOREST
Mailing Address - State:NC
Mailing Address - Zip Code:27587-6577
Mailing Address - Country:US
Mailing Address - Phone:919-570-7080
Mailing Address - Fax:919-570-7081
Practice Address - Street 1:843 WAKE FOREST BUSINESS PARK
Practice Address - Street 2:SUITE 110
Practice Address - City:WAKE FOREST
Practice Address - State:NC
Practice Address - Zip Code:27587-6577
Practice Address - Country:US
Practice Address - Phone:919-570-7080
Practice Address - Fax:919-570-7081
Is Sole Proprietor?:No
Enumeration Date:2006-05-09
Last Update Date:2008-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2757225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant