Provider Demographics
NPI:1952535478
Name:LEE, LESLIE SHISLER (PT)
Entity Type:Individual
Prefix:
First Name:LESLIE
Middle Name:SHISLER
Last Name:LEE
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3181 WEST 9000 SOUTH #103
Mailing Address - Street 2:
Mailing Address - City:WEST JORDAN
Mailing Address - State:UT
Mailing Address - Zip Code:84088-8623
Mailing Address - Country:US
Mailing Address - Phone:801-561-1061
Mailing Address - Fax:801-561-1570
Practice Address - Street 1:3181 WEST 9000 SOUTH #103
Practice Address - Street 2:
Practice Address - City:WEST JORDAN
Practice Address - State:UT
Practice Address - Zip Code:84088-8623
Practice Address - Country:US
Practice Address - Phone:801-561-1061
Practice Address - Fax:801-561-1570
Is Sole Proprietor?:No
Enumeration Date:2009-05-12
Last Update Date:2011-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT120485-2401225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist