Provider Demographics
NPI:1720422454
Name:BROCHHAUSEN, LESLIE ANN (LPTA)
Entity Type:Individual
Prefix:MRS
First Name:LESLIE
Middle Name:ANN
Last Name:BROCHHAUSEN
Suffix:
Gender:F
Credentials:LPTA
Other - Prefix:MS
Other - First Name:LESLIE
Other - Middle Name:ANN
Other - Last Name:WILLIAMS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPTA
Mailing Address - Street 1:6767 LAKE WOODLANDS DR
Mailing Address - Street 2:SUITE F
Mailing Address - City:THE WOODLANDS
Mailing Address - State:TX
Mailing Address - Zip Code:77382-2566
Mailing Address - Country:US
Mailing Address - Phone:281-364-1122
Mailing Address - Fax:281-419-3101
Practice Address - Street 1:6767 LAKE WOODLANDS DR
Practice Address - Street 2:SUITE F
Practice Address - City:THE WOODLANDS
Practice Address - State:TX
Practice Address - Zip Code:77382-2566
Practice Address - Country:US
Practice Address - Phone:281-364-1122
Practice Address - Fax:281-419-3101
Is Sole Proprietor?:No
Enumeration Date:2013-04-24
Last Update Date:2013-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2087780225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant