Provider Demographics
NPI:1760719785
Name:SLATER, LESLI MARIE (MSPT)
Entity Type:Individual
Prefix:
First Name:LESLI
Middle Name:MARIE
Last Name:SLATER
Suffix:
Gender:F
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:281 SAWYER DR
Mailing Address - Street 2:STE 200
Mailing Address - City:DURANGO
Mailing Address - State:CO
Mailing Address - Zip Code:81303-3409
Mailing Address - Country:US
Mailing Address - Phone:970-385-3498
Mailing Address - Fax:970-259-2618
Practice Address - Street 1:281 SAWYER DR
Practice Address - Street 2:STE 200
Practice Address - City:DURANGO
Practice Address - State:CO
Practice Address - Zip Code:81303-3409
Practice Address - Country:US
Practice Address - Phone:970-385-3498
Practice Address - Fax:970-259-2618
Is Sole Proprietor?:No
Enumeration Date:2009-11-11
Last Update Date:2011-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO6266225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist