Provider Demographics
NPI:1205173598
Name:GAGE, LESLIE (CFO, CFTS)
Entity type:Individual
Prefix:MS
First Name:LESLIE
Middle Name:
Last Name:GAGE
Suffix:
Gender:F
Credentials:CFO, CFTS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1575 S. BERETANIA ST.
Mailing Address - Street 2:SUITE 1B
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96826-4862
Mailing Address - Country:US
Mailing Address - Phone:808-949-8389
Mailing Address - Fax:
Practice Address - Street 1:1575 S. BERETANIA ST.
Practice Address - Street 2:SUITE 1B
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96826-4862
Practice Address - Country:US
Practice Address - Phone:808-949-8389
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-07
Last Update Date:2013-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225000000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotic Fitter