Provider Demographics
NPI:1760768600
Name:LEE, LESLIANNE (PT)
Entity Type:Individual
Prefix:
First Name:LESLIANNE
Middle Name:
Last Name:LEE
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 1:48 WOODS LN
Mailing Address - Street 2:
Mailing Address - City:LOS ALTOS
Mailing Address - State:CA
Mailing Address - Zip Code:94024-7153
Mailing Address - Country:US
Mailing Address - Phone:650-386-1342
Mailing Address - Fax:650-386-1342
Practice Address - Street 1:48 WOODS LN
Practice Address - Street 2:
Practice Address - City:LOS ALTOS
Practice Address - State:CA
Practice Address - Zip Code:94024-7153
Practice Address - Country:US
Practice Address - Phone:650-386-1342
Practice Address - Fax:650-386-1342
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-24
Last Update Date:2011-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT22124225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist