Provider Demographics
NPI:1134259815
Name:LESLIE, NADIA NICOLE (ATC,LAT)
Entity type:Individual
Prefix:MRS
First Name:NADIA
Middle Name:NICOLE
Last Name:LESLIE
Suffix:
Gender:F
Credentials:ATC,LAT
Other - Prefix:MS
Other - First Name:NADIA
Other - Middle Name:NICOLE
Other - Last Name:COLE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:125 E GREEN ACRES DR
Mailing Address - Street 2:
Mailing Address - City:HOBBS
Mailing Address - State:NM
Mailing Address - Zip Code:88240-4426
Mailing Address - Country:US
Mailing Address - Phone:915-731-5302
Mailing Address - Fax:
Practice Address - Street 1:1 THUNDERBIRD CIR
Practice Address - Street 2:ATHLETICS DEPARTMENT
Practice Address - City:HOBBS
Practice Address - State:NM
Practice Address - Zip Code:88240-0200
Practice Address - Country:US
Practice Address - Phone:575-492-2745
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-06
Last Update Date:2015-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAT29422255A2300X
NM5332255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer