Provider Demographics
NPI:1336373091
Name:SOMMERS, LESLIE LEVINE (PT)
Entity Type:Individual
Prefix:
First Name:LESLIE
Middle Name:LEVINE
Last Name:SOMMERS
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:LESLIE
Other - Middle Name:
Other - Last Name:LEVINE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:24630 WASHINGTON AVE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:MURRIETA
Mailing Address - State:CA
Mailing Address - Zip Code:92562-6177
Mailing Address - Country:US
Mailing Address - Phone:951-696-9353
Mailing Address - Fax:951-973-7216
Practice Address - Street 1:1932 HACIENDA DR
Practice Address - Street 2:
Practice Address - City:VISTA
Practice Address - State:CA
Practice Address - Zip Code:92081-6024
Practice Address - Country:US
Practice Address - Phone:760-630-2258
Practice Address - Fax:760-630-5367
Is Sole Proprietor?:No
Enumeration Date:2009-05-11
Last Update Date:2009-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT 14171225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist