Provider Demographics
NPI:1952589368
Name:MACLAGGAN, LESLIE ANNE (MPT)
Entity Type:Individual
Prefix:MRS
First Name:LESLIE
Middle Name:ANNE
Last Name:MACLAGGAN
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:911 COUNTRY CLUB RD
Mailing Address - Street 2:SUITE 150
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97401-6044
Mailing Address - Country:US
Mailing Address - Phone:541-683-5139
Mailing Address - Fax:541-683-5783
Practice Address - Street 1:911 COUNTRY CLUB RD
Practice Address - Street 2:SUITE 150
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97401-6044
Practice Address - Country:US
Practice Address - Phone:541-683-5139
Practice Address - Fax:541-683-5783
Is Sole Proprietor?:No
Enumeration Date:2008-02-07
Last Update Date:2010-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA34463225100000X
OR5820225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORP00796050OtherRAILROAD MEDICARE