Provider Demographics
NPI:1780967877
Name:ELLIOTT, LESLIE (LMT, CNMT, BAS)
Entity type:Individual
Prefix:MS
First Name:LESLIE
Middle Name:
Last Name:ELLIOTT
Suffix:
Gender:F
Credentials:LMT, CNMT, BAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12415 SILENT BROOK TRL N
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32225-5129
Mailing Address - Country:US
Mailing Address - Phone:904-742-2960
Mailing Address - Fax:
Practice Address - Street 1:12415 SILENT BROOK TRL N
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32225-5129
Practice Address - Country:US
Practice Address - Phone:904-742-2960
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-24
Last Update Date:2011-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA50357172P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172P00000XOther Service ProvidersNaprapath