Provider Demographics
NPI:1316131659
Name:JONES, LESLIE (RPT)
Entity type:Individual
Prefix:MRS
First Name:LESLIE
Middle Name:
Last Name:JONES
Suffix:
Gender:F
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1019 GLEN CANYON WAY
Mailing Address - Street 2:
Mailing Address - City:BREA
Mailing Address - State:CA
Mailing Address - Zip Code:92821-2631
Mailing Address - Country:US
Mailing Address - Phone:714-671-1153
Mailing Address - Fax:
Practice Address - Street 1:1019 GLEN CANYON WAY
Practice Address - Street 2:
Practice Address - City:BREA
Practice Address - State:CA
Practice Address - Zip Code:92821-2631
Practice Address - Country:US
Practice Address - Phone:714-671-1153
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-29
Last Update Date:2007-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT8186225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist