Provider Demographics
NPI:1144702135
Name:LESAGE, LESLIE MARIE (DPT)
Entity type:Individual
Prefix:
First Name:LESLIE
Middle Name:MARIE
Last Name:LESAGE
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:749 BEACH DR
Mailing Address - Street 2:
Mailing Address - City:DESTIN
Mailing Address - State:FL
Mailing Address - Zip Code:32541-1620
Mailing Address - Country:US
Mailing Address - Phone:912-631-3176
Mailing Address - Fax:
Practice Address - Street 1:138 SANDESTIN LN
Practice Address - Street 2:
Practice Address - City:DESTIN
Practice Address - State:FL
Practice Address - Zip Code:32550-5815
Practice Address - Country:US
Practice Address - Phone:850-267-2887
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-05
Last Update Date:2018-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT32986225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist