Provider Demographics
NPI:1770851651
Name:FACEMYER, LESLIE Z (LMT)
Entity Type:Individual
Prefix:
First Name:LESLIE
Middle Name:Z
Last Name:FACEMYER
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:143 PEYTON ST
Mailing Address - Street 2:
Mailing Address - City:BARBOURSVILLE
Mailing Address - State:WV
Mailing Address - Zip Code:25504-2063
Mailing Address - Country:US
Mailing Address - Phone:304-697-2035
Mailing Address - Fax:304-523-1485
Practice Address - Street 1:143 PEYTON ST
Practice Address - Street 2:
Practice Address - City:BARBOURSVILLE
Practice Address - State:WV
Practice Address - Zip Code:25504-2063
Practice Address - Country:US
Practice Address - Phone:304-697-2035
Practice Address - Fax:304-523-1485
Is Sole Proprietor?:No
Enumeration Date:2011-12-07
Last Update Date:2011-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV1999-0263225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist