Provider Demographics
NPI:1831728815
Name:LESLIE, JENA (ATC, LAT)
Entity type:Individual
Prefix:
First Name:JENA
Middle Name:
Last Name:LESLIE
Suffix:
Gender:F
Credentials:ATC, LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1744 NATURAL BRIDGE DR
Mailing Address - Street 2:
Mailing Address - City:FRISCO
Mailing Address - State:TX
Mailing Address - Zip Code:75036-4354
Mailing Address - Country:US
Mailing Address - Phone:402-730-0237
Mailing Address - Fax:
Practice Address - Street 1:6401 PARKWOOD DR
Practice Address - Street 2:
Practice Address - City:FRISCO
Practice Address - State:TX
Practice Address - Zip Code:75034-7239
Practice Address - Country:US
Practice Address - Phone:469-633-5566
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-02
Last Update Date:2020-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAT31362255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer