Provider Demographics
NPI:1023416930
Name:CUTLER, LESLIE ANN (PT)
Entity type:Individual
Prefix:MRS
First Name:LESLIE
Middle Name:ANN
Last Name:CUTLER
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MISS
Other - First Name:LESLIE
Other - Middle Name:ANN
Other - Last Name:ELLSWORTH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:710 E 1ST ST
Mailing Address - Street 2:
Mailing Address - City:ANKENY
Mailing Address - State:IA
Mailing Address - Zip Code:50021-2007
Mailing Address - Country:US
Mailing Address - Phone:515-224-4358
Mailing Address - Fax:
Practice Address - Street 1:710 E 1ST ST
Practice Address - Street 2:
Practice Address - City:ANKENY
Practice Address - State:IA
Practice Address - Zip Code:50021-2007
Practice Address - Country:US
Practice Address - Phone:515-224-4358
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-12-08
Last Update Date:2015-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA03921225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IAI19172076Medicare PIN
IAIB3481014Medicare PIN
IAI19172Medicare PIN
IAIB3481Medicare PIN