Provider Demographics
NPI:1649722109
Name:WATERS, LESLEY (NYS LMT)
Entity type:Individual
Prefix:
First Name:LESLEY
Middle Name:
Last Name:WATERS
Suffix:
Gender:F
Credentials:NYS LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21 BULLARD LN
Mailing Address - Street 2:
Mailing Address - City:SARATOGA SPRINGS
Mailing Address - State:NY
Mailing Address - Zip Code:12866-9321
Mailing Address - Country:US
Mailing Address - Phone:518-421-6160
Mailing Address - Fax:
Practice Address - Street 1:21 BULLARD LN
Practice Address - Street 2:
Practice Address - City:SARATOGA SPRINGS
Practice Address - State:NY
Practice Address - Zip Code:12866-9321
Practice Address - Country:US
Practice Address - Phone:518-421-6160
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-01
Last Update Date:2016-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY013853225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist