Provider Demographics
NPI:1487906053
Name:LESLIE, NANCY ANN (LMT)
Entity type:Individual
Prefix:
First Name:NANCY
Middle Name:ANN
Last Name:LESLIE
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:336 POPLAR ST
Mailing Address - Street 2:
Mailing Address - City:LEHIGH ACRES
Mailing Address - State:FL
Mailing Address - Zip Code:33974-0481
Mailing Address - Country:US
Mailing Address - Phone:239-645-7940
Mailing Address - Fax:
Practice Address - Street 1:2718 LEE BLVD
Practice Address - Street 2:SUITE C
Practice Address - City:LEHIGH ACRES
Practice Address - State:FL
Practice Address - Zip Code:33971-1537
Practice Address - Country:US
Practice Address - Phone:239-694-9102
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-10-08
Last Update Date:2012-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA42332225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist