Provider Demographics
NPI:1902965403
Name:HAYDEN, LESLIE ANNE (RPT)
Entity Type:Individual
Prefix:
First Name:LESLIE
Middle Name:ANNE
Last Name:HAYDEN
Suffix:
Gender:F
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 397
Mailing Address - Street 2:
Mailing Address - City:WHITEFISH
Mailing Address - State:MT
Mailing Address - Zip Code:59937-0397
Mailing Address - Country:US
Mailing Address - Phone:406-261-3823
Mailing Address - Fax:
Practice Address - Street 1:185 COMMONS LOOP
Practice Address - Street 2:SUITE C
Practice Address - City:KALISPELL
Practice Address - State:MT
Practice Address - Zip Code:59901-1913
Practice Address - Country:US
Practice Address - Phone:406-261-3823
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT5502251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT0346125Medicaid
MT61025OtherBCBS AND CHIPS