Provider Demographics
NPI:1356384937
Name:MILLER, LESLIE DEAN (PT)
Entity type:Individual
Prefix:MRS
First Name:LESLIE
Middle Name:DEAN
Last Name:MILLER
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:148 LINDEN ST
Mailing Address - Street 2:SUITE 106
Mailing Address - City:WELLESLEY
Mailing Address - State:MA
Mailing Address - Zip Code:02482-7900
Mailing Address - Country:US
Mailing Address - Phone:781-235-6440
Mailing Address - Fax:781-235-3373
Practice Address - Street 1:148 LINDEN ST
Practice Address - Street 2:SUITE 106
Practice Address - City:WELLESLEY
Practice Address - State:MA
Practice Address - Zip Code:02482-7900
Practice Address - Country:US
Practice Address - Phone:781-235-6440
Practice Address - Fax:781-235-3373
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-13
Last Update Date:2008-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2577174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAY68179OtherMEDICARE NUMBER
MA05-0562697OtherTAX IDENTIFICATION NUMBER
MAY66819OtherBLUE CROSS & BLUE SHEILD
MA2577OtherPT LISCENCE