Provider Demographics
NPI:1902031768
Name:KING, LESLEY-ANNE (MS, ATC)
Entity Type:Individual
Prefix:
First Name:LESLEY-ANNE
Middle Name:
Last Name:KING
Suffix:
Gender:F
Credentials:MS, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5821 SAN AMARO DR
Mailing Address - Street 2:
Mailing Address - City:CORAL GABLES
Mailing Address - State:FL
Mailing Address - Zip Code:33146-2402
Mailing Address - Country:US
Mailing Address - Phone:305-284-4734
Mailing Address - Fax:305-284-3008
Practice Address - Street 1:5821 SAN AMARO DR
Practice Address - Street 2:
Practice Address - City:CORAL GABLES
Practice Address - State:FL
Practice Address - Zip Code:33146-2402
Practice Address - Country:US
Practice Address - Phone:305-284-4734
Practice Address - Fax:305-284-3008
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-22
Last Update Date:2016-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAL 26092255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer