Provider Demographics
NPI:1801616768
Name:LEFTWICH, TESS
Entity type:Individual
Prefix:
First Name:TESS
Middle Name:
Last Name:LEFTWICH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:711 E PLATTE AVE APT 2
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80903-3561
Mailing Address - Country:US
Mailing Address - Phone:804-898-0005
Mailing Address - Fax:
Practice Address - Street 1:157 FONTAINE BLVD
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80911-2110
Practice Address - Country:US
Practice Address - Phone:719-388-3558
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-15
Last Update Date:2024-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor