Provider Demographics
NPI:1306944731
Name:TUMMEL, LESLIE TALBOTT (PT, DPT)
Entity type:Individual
Prefix:MRS
First Name:LESLIE
Middle Name:TALBOTT
Last Name:TUMMEL
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 1:1139 BUXTON DR
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37922-8008
Mailing Address - Country:US
Mailing Address - Phone:865-357-2405
Mailing Address - Fax:
Practice Address - Street 1:10420 KINGSTON PIKE STE H
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37922-3261
Practice Address - Country:US
Practice Address - Phone:865-690-5494
Practice Address - Fax:865-693-6248
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN7666225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN446557Medicare ID - Type Unspecified