Provider Demographics
NPI:1013108802
Name:FUCHS, LESLIE A (PT)
Entity Type:Individual
Prefix:MR
First Name:LESLIE
Middle Name:A
Last Name:FUCHS
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:351 NE FRANKLIN ST
Mailing Address - Street 2:
Mailing Address - City:LAKE CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32055-3089
Mailing Address - Country:US
Mailing Address - Phone:386-754-8215
Mailing Address - Fax:386-754-8216
Practice Address - Street 1:351 NE FRANKLIN ST
Practice Address - Street 2:
Practice Address - City:LAKE CITY
Practice Address - State:FL
Practice Address - Zip Code:32055-3089
Practice Address - Country:US
Practice Address - Phone:386-754-8215
Practice Address - Fax:386-754-8216
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-06
Last Update Date:2007-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT18526225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist