Provider Demographics
NPI:1538168042
Name:LESLIE, AMBERLY D (PT)
Entity type:Individual
Prefix:MS
First Name:AMBERLY
Middle Name:D
Last Name:LESLIE
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:PO BOX 866
Mailing Address - Street 2:
Mailing Address - City:GEORGETOWN
Mailing Address - State:KY
Mailing Address - Zip Code:40324-0866
Mailing Address - Country:US
Mailing Address - Phone:502-863-4242
Mailing Address - Fax:502-570-9813
Practice Address - Street 1:751 SLONE DR
Practice Address - Street 2:#15
Practice Address - City:GEORGETOWN
Practice Address - State:KY
Practice Address - Zip Code:40324-1162
Practice Address - Country:US
Practice Address - Phone:502-863-4242
Practice Address - Fax:502-570-9813
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY004499225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
5023504Medicare ID - Type Unspecified