Provider Demographics
NPI:1245538024
Name:PRUITT, LESLIE ANN (DPT)
Entity type:Individual
Prefix:
First Name:LESLIE
Middle Name:ANN
Last Name:PRUITT
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:LESLIE
Other - Middle Name:ANN
Other - Last Name:ARNDT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:17624 133RD PL SE
Mailing Address - Street 2:
Mailing Address - City:RENTON
Mailing Address - State:WA
Mailing Address - Zip Code:98058-6839
Mailing Address - Country:US
Mailing Address - Phone:206-356-3548
Mailing Address - Fax:
Practice Address - Street 1:909 UNIVERSITY ST
Practice Address - Street 2:217
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98101-2772
Practice Address - Country:US
Practice Address - Phone:206-341-1131
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-03-03
Last Update Date:2011-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT60209140225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1245538024Medicaid
WA0277791OtherDEPT OF LABOR & INDUSTRIES