Provider Demographics
NPI:1366428674
Name:LESKO, JENNIFER ANN (PHYSICAL THERAPIST)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:ANN
Last Name:LESKO
Suffix:
Gender:F
Credentials:PHYSICAL THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16083 SW UPPER BOONES FERRY RD
Mailing Address - Street 2:STE. 300
Mailing Address - City:TIGARD
Mailing Address - State:OR
Mailing Address - Zip Code:97224-7736
Mailing Address - Country:US
Mailing Address - Phone:800-219-8835
Mailing Address - Fax:503-639-9699
Practice Address - Street 1:428 1ST AVE W
Practice Address - Street 2:TAI QUEEN ANN PHYSICAL THERAPY
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98119-4018
Practice Address - Country:US
Practice Address - Phone:206-352-0105
Practice Address - Fax:206-352-0106
Is Sole Proprietor?:No
Enumeration Date:2005-12-19
Last Update Date:2012-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT00008000225100000X
OR3921225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8370926Medicaid
WA1366428674Medicaid
WA8370926Medicaid