Provider Demographics
NPI:1669598983
Name:GREEN, LESLIE (PT)
Entity type:Individual
Prefix:
First Name:LESLIE
Middle Name:
Last Name:GREEN
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 1:575 DEKALB INDUSTRIAL WAY
Mailing Address - Street 2:SUITE 103
Mailing Address - City:FRANKLIN
Mailing Address - State:TN
Mailing Address - Zip Code:37067-2626
Mailing Address - Country:US
Mailing Address - Phone:404-296-8511
Mailing Address - Fax:404-296-8514
Practice Address - Street 1:575 DEKALB INDUSTRIAL WAY
Practice Address - Street 2:SUITE 103
Practice Address - City:FRANKLIN
Practice Address - State:TN
Practice Address - Zip Code:37067-2626
Practice Address - Country:US
Practice Address - Phone:404-296-8511
Practice Address - Fax:404-296-8514
Is Sole Proprietor?:No
Enumeration Date:2007-03-21
Last Update Date:2011-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT000604225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist