Provider Demographics
NPI:1861821720
Name:GOTTESMAN, LESLIE (LMT)
Entity Type:Individual
Prefix:
First Name:LESLIE
Middle Name:
Last Name:GOTTESMAN
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 1:800 QUINTANA RD
Mailing Address - Street 2:SUITE 1B
Mailing Address - City:MORRO BAY
Mailing Address - State:CA
Mailing Address - Zip Code:93442-2300
Mailing Address - Country:US
Mailing Address - Phone:805-772-6131
Mailing Address - Fax:805-772-5281
Practice Address - Street 1:800 QUINTANA RD
Practice Address - Street 2:SUITE 1B
Practice Address - City:MORRO BAY
Practice Address - State:CA
Practice Address - Zip Code:93442-2300
Practice Address - Country:US
Practice Address - Phone:805-772-6131
Practice Address - Fax:805-772-5281
Is Sole Proprietor?:No
Enumeration Date:2013-11-01
Last Update Date:2013-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CACA37947225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACA37947OtherAMERICAN MASSAGE THERAPY ASSOCIATION