Provider Demographics
NPI:1477503035
Name:MOTTELER, LESLIE J (PT)
Entity type:Individual
Prefix:MRS
First Name:LESLIE
Middle Name:J
Last Name:MOTTELER
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 1:221 HIDDEN CREEK CIR
Mailing Address - Street 2:
Mailing Address - City:SALISBURY
Mailing Address - State:NC
Mailing Address - Zip Code:28147-7216
Mailing Address - Country:US
Mailing Address - Phone:704-467-7213
Mailing Address - Fax:704-633-5991
Practice Address - Street 1:401 MOCKSVILLE AVE
Practice Address - Street 2:
Practice Address - City:SALISBURY
Practice Address - State:NC
Practice Address - Zip Code:28144-2735
Practice Address - Country:US
Practice Address - Phone:704-633-4606
Practice Address - Fax:704-633-5991
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9133225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7212025Medicaid