Provider Demographics
NPI:1952379752
Name:WILLIAMS, LESLIE LEAH (PT)
Entity Type:Individual
Prefix:MS
First Name:LESLIE
Middle Name:LEAH
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:LESLIE
Other - Middle Name:LEAH
Other - Last Name:MCGINN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3208 SHADY GLEN DR
Mailing Address - Street 2:
Mailing Address - City:GRAPEVINE
Mailing Address - State:TX
Mailing Address - Zip Code:76051-6502
Mailing Address - Country:US
Mailing Address - Phone:817-354-1336
Mailing Address - Fax:
Practice Address - Street 1:100 W SOUTHLAKE BLVD
Practice Address - Street 2:SUITE 420
Practice Address - City:SOUTHLAKE
Practice Address - State:TX
Practice Address - Zip Code:76092-6166
Practice Address - Country:US
Practice Address - Phone:817-442-8600
Practice Address - Fax:817-442-8603
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1160040225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist