Provider Demographics
NPI:1982102364
Name:KREMER, LESLIE J (PT)
Entity Type:Individual
Prefix:MRS
First Name:LESLIE
Middle Name:J
Last Name:KREMER
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 1:806 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:EPWORTH
Mailing Address - State:IA
Mailing Address - Zip Code:52045-9704
Mailing Address - Country:US
Mailing Address - Phone:563-876-0061
Mailing Address - Fax:
Practice Address - Street 1:806 W MAIN ST
Practice Address - Street 2:
Practice Address - City:EPWORTH
Practice Address - State:IA
Practice Address - Zip Code:52045-9704
Practice Address - Country:US
Practice Address - Phone:563-503-9282
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-31
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA03786225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty