Provider Demographics
NPI:1952447807
Name:CLEMENTS, LESLIE (PT)
Entity Type:Individual
Prefix:MS
First Name:LESLIE
Middle Name:
Last Name:CLEMENTS
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MS
Other - First Name:LESLIE
Other - Middle Name:
Other - Last Name:HOWARD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:1206 E WARNER RD
Mailing Address - Street 2:SUITE C
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85296-3132
Mailing Address - Country:US
Mailing Address - Phone:480-747-8433
Mailing Address - Fax:480-718-8433
Practice Address - Street 1:1206 E WARNER RD
Practice Address - Street 2:SUITE C
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85296-3132
Practice Address - Country:US
Practice Address - Phone:480-747-8433
Practice Address - Fax:480-718-8433
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-29
Last Update Date:2014-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ2940225100000X
UT278397-2401225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ76681Medicare ID - Type Unspecified