Provider Demographics
NPI:1316969280
Name:HYMAN, LESLIE MARIE (PT)
Entity type:Individual
Prefix:MRS
First Name:LESLIE
Middle Name:MARIE
Last Name:HYMAN
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1830 WHITTEN RD
Mailing Address - Street 2:
Mailing Address - City:WATERLOO
Mailing Address - State:SC
Mailing Address - Zip Code:29384-5158
Mailing Address - Country:US
Mailing Address - Phone:864-414-3652
Mailing Address - Fax:
Practice Address - Street 1:35 RAY E TALLEY CT
Practice Address - Street 2:
Practice Address - City:SIMPSONVILLE
Practice Address - State:SC
Practice Address - Zip Code:29680-6772
Practice Address - Country:US
Practice Address - Phone:864-967-4600
Practice Address - Fax:864-967-0935
Is Sole Proprietor?:No
Enumeration Date:2006-07-23
Last Update Date:2018-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC11972251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCTH1436Medicaid