Provider Demographics
NPI:1760215073
Name:LINGO, LESLIE (PT, DPT)
Entity type:Individual
Prefix:
First Name:LESLIE
Middle Name:
Last Name:LINGO
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:701 N PINE ST
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:71852-4240
Mailing Address - Country:US
Mailing Address - Phone:870-200-0465
Mailing Address - Fax:
Practice Address - Street 1:1401 SW PARKRIDGE BLVD STE A
Practice Address - Street 2:
Practice Address - City:LAWTON
Practice Address - State:OK
Practice Address - Zip Code:73505-9200
Practice Address - Country:US
Practice Address - Phone:580-730-8015
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-22
Last Update Date:2024-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR5541225100000X
OKCP033405T225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist