Provider Demographics
NPI:1528304698
Name:DYKSTRA-ORDANES, LESLIE JEAN (PT)
Entity type:Individual
Prefix:MS
First Name:LESLIE
Middle Name:JEAN
Last Name:DYKSTRA-ORDANES
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MS
Other - First Name:LESLIE
Other - Middle Name:JEAN
Other - Last Name:DYKSTRA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:5530 E HANBURY ST
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90808-2005
Mailing Address - Country:US
Mailing Address - Phone:562-682-1884
Mailing Address - Fax:
Practice Address - Street 1:5122 KATELLA AVE STE 16
Practice Address - Street 2:
Practice Address - City:LOS ALAMITOS
Practice Address - State:CA
Practice Address - Zip Code:90720-2838
Practice Address - Country:US
Practice Address - Phone:562-795-5295
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-12-18
Last Update Date:2021-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT21523225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist