Provider Demographics
NPI:1851949762
Name:SANTELICES, LESLIE ANNE GIANAN (PT)
Entity Type:Individual
Prefix:
First Name:LESLIE ANNE
Middle Name:GIANAN
Last Name:SANTELICES
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 1:5423 83RD ST
Mailing Address - Street 2:
Mailing Address - City:ELMHURST
Mailing Address - State:NY
Mailing Address - Zip Code:11373-4723
Mailing Address - Country:US
Mailing Address - Phone:917-238-7358
Mailing Address - Fax:
Practice Address - Street 1:675 THIRD AVENUE
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10017-1001
Practice Address - Country:US
Practice Address - Phone:212-922-1001
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-04
Last Update Date:2019-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY043679208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation