Provider Demographics
NPI:1972083061
Name:BENEDICT, LESLIE R (PT)
Entity Type:Individual
Prefix:MS
First Name:LESLIE
Middle Name:R
Last Name:BENEDICT
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 1:6551 BRIARWOOD PL
Mailing Address - Street 2:
Mailing Address - City:ZIONSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46077-8541
Mailing Address - Country:US
Mailing Address - Phone:317-701-6572
Mailing Address - Fax:
Practice Address - Street 1:4904 WAR ADMIRAL DR
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46237-9737
Practice Address - Country:US
Practice Address - Phone:317-884-5746
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-17
Last Update Date:2018-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN05005780A225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist