Provider Demographics
NPI:1841400355
Name:FAUSNIGHT, LESLI (PT)
Entity Type:Individual
Prefix:
First Name:LESLI
Middle Name:
Last Name:FAUSNIGHT
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 1:1-293 CO. RD. U
Mailing Address - Street 2:
Mailing Address - City:LIBERTY CENTER
Mailing Address - State:OH
Mailing Address - Zip Code:43532
Mailing Address - Country:US
Mailing Address - Phone:419-461-1088
Mailing Address - Fax:419-474-5165
Practice Address - Street 1:3949 SUNFOREST CT
Practice Address - Street 2:SUITE 101
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43623-4473
Practice Address - Country:US
Practice Address - Phone:419-474-3399
Practice Address - Fax:419-474-5165
Is Sole Proprietor?:No
Enumeration Date:2007-05-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPT9186225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2208864Medicaid
OH2208864Medicaid