Provider Demographics
NPI:1003647108
Name:HUMPHREY, LESLIE YARELI (DPT)
Entity type:Individual
Prefix:MRS
First Name:LESLIE
Middle Name:YARELI
Last Name:HUMPHREY
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:LESLIE
Other - Middle Name:YARELI
Other - Last Name:MEJIA ESPINOZA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:32205 AURORA VISTA RD APT A
Mailing Address - Street 2:
Mailing Address - City:CATHEDRAL CITY
Mailing Address - State:CA
Mailing Address - Zip Code:92234-9233
Mailing Address - Country:US
Mailing Address - Phone:760-641-7249
Mailing Address - Fax:
Practice Address - Street 1:78078 COUNTRY CLUB DR STE 205
Practice Address - Street 2:
Practice Address - City:BERMUDA DUNES
Practice Address - State:CA
Practice Address - Zip Code:92203-8175
Practice Address - Country:US
Practice Address - Phone:760-345-9934
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-09
Last Update Date:2024-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA306653225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist