Provider Demographics
NPI:1336738947
Name:GASTON, LESLEE N (PTA)
Entity Type:Individual
Prefix:
First Name:LESLEE
Middle Name:N
Last Name:GASTON
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:117 W 5TH ST STE 200
Mailing Address - Street 2:
Mailing Address - City:BARTLESVILLE
Mailing Address - State:OK
Mailing Address - Zip Code:74003-6615
Mailing Address - Country:US
Mailing Address - Phone:918-203-3313
Mailing Address - Fax:918-512-4082
Practice Address - Street 1:117 W 5TH ST STE 200
Practice Address - Street 2:
Practice Address - City:BARTLESVILLE
Practice Address - State:OK
Practice Address - Zip Code:74003-6615
Practice Address - Country:US
Practice Address - Phone:918-203-3313
Practice Address - Fax:918-512-4082
Is Sole Proprietor?:No
Enumeration Date:2021-01-18
Last Update Date:2021-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2326225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK2326OtherSTATE