Provider Demographics
NPI:1902120959
Name:CARTER, LESLIE ANNE (PT)
Entity Type:Individual
Prefix:
First Name:LESLIE ANNE
Middle Name:
Last Name:CARTER
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 1:15477 VENTURA BLVD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:SHERMAN OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91403-3006
Mailing Address - Country:US
Mailing Address - Phone:310-539-8800
Mailing Address - Fax:310-698-5410
Practice Address - Street 1:15477 VENTURA BLVD
Practice Address - Street 2:SUITE 200
Practice Address - City:SHERMAN OAKS
Practice Address - State:CA
Practice Address - Zip Code:91403-3006
Practice Address - Country:US
Practice Address - Phone:310-539-8800
Practice Address - Fax:310-698-5410
Is Sole Proprietor?:No
Enumeration Date:2010-03-19
Last Update Date:2013-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA39755225100000X
TX1193680225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist