Provider Demographics
NPI:1881462570
Name:LESLIE, SCOTT (PTA)
Entity type:Individual
Prefix:
First Name:SCOTT
Middle Name:
Last Name:LESLIE
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:771 CORPORATE DR STE 1020
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40503-5482
Mailing Address - Country:US
Mailing Address - Phone:859-276-5369
Mailing Address - Fax:859-276-1783
Practice Address - Street 1:771 CORPORATE DR STE 1020
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40503-5482
Practice Address - Country:US
Practice Address - Phone:859-276-5369
Practice Address - Fax:859-276-1783
Is Sole Proprietor?:No
Enumeration Date:2023-12-13
Last Update Date:2023-12-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KYA03966225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant