Provider Demographics
NPI:1972026458
Name:KARGBO, LESLEY ALUSINE
Entity Type:Individual
Prefix:DR
First Name:LESLEY
Middle Name:ALUSINE
Last Name:KARGBO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5815 HORSESHOE FLS
Mailing Address - Street 2:
Mailing Address - City:MISSOURI CITY
Mailing Address - State:TX
Mailing Address - Zip Code:77459-6915
Mailing Address - Country:US
Mailing Address - Phone:281-773-8180
Mailing Address - Fax:
Practice Address - Street 1:7746 HIGHWAY 6 STE M
Practice Address - Street 2:
Practice Address - City:MISSOURI CITY
Practice Address - State:TX
Practice Address - Zip Code:77459-4780
Practice Address - Country:US
Practice Address - Phone:281-971-3505
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-17
Last Update Date:2017-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX11964902251S0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2251S0007XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistSportsGroup - Single Specialty