Provider Demographics
NPI:1538389937
Name:LESHKO, MARY BETH ANN (PTA)
Entity type:Individual
Prefix:MRS
First Name:MARY BETH
Middle Name:ANN
Last Name:LESHKO
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:511 E BLAINE ST
Mailing Address - Street 2:
Mailing Address - City:MCADOO
Mailing Address - State:PA
Mailing Address - Zip Code:18237-2205
Mailing Address - Country:US
Mailing Address - Phone:570-929-1079
Mailing Address - Fax:
Practice Address - Street 1:149 S HUNTER HWY
Practice Address - Street 2:
Practice Address - City:DRUMS
Practice Address - State:PA
Practice Address - Zip Code:18222-2422
Practice Address - Country:US
Practice Address - Phone:570-788-7321
Practice Address - Fax:570-788-7267
Is Sole Proprietor?:No
Enumeration Date:2007-04-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PATE000254L174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist