Provider Demographics
NPI:1861517542
Name:MOORE, LESLEY HARRINGTON (PT)
Entity type:Individual
Prefix:MRS
First Name:LESLEY
Middle Name:HARRINGTON
Last Name:MOORE
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MISS
Other - First Name:LESLEY
Other - Middle Name:JEAN
Other - Last Name:HARRINGTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:10 PARKER LN STE 1
Mailing Address - Street 2:
Mailing Address - City:PINEHURST
Mailing Address - State:NC
Mailing Address - Zip Code:28374-7903
Mailing Address - Country:US
Mailing Address - Phone:919-774-7338
Mailing Address - Fax:919-718-9468
Practice Address - Street 1:10 PARKER LN STE 1
Practice Address - Street 2:
Practice Address - City:PINEHURST
Practice Address - State:NC
Practice Address - Zip Code:28374-7903
Practice Address - Country:US
Practice Address - Phone:919-774-7338
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-20
Last Update Date:2014-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC24752251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC3403400Medicaid
NC079NGOtherBCBS
NC562033116OtherTRICARE-TAX ID