Provider Demographics
NPI:1194140558
Name:LESKO, DENISE (PTA)
Entity type:Individual
Prefix:MS
First Name:DENISE
Middle Name:
Last Name:LESKO
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 1:64 WOODSIDE DR
Mailing Address - Street 2:
Mailing Address - City:FREELAND
Mailing Address - State:PA
Mailing Address - Zip Code:18224-3025
Mailing Address - Country:US
Mailing Address - Phone:570-636-1438
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:570-708-2615
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-21
Last Update Date:2014-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PATE1002212225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant