Provider Demographics
NPI:1588851828
Name:SISSON, LESLEIGH B (CFOM)
Entity type:Individual
Prefix:
First Name:LESLEIGH
Middle Name:B
Last Name:SISSON
Suffix:
Gender:F
Credentials:CFOM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 SHADOW LN STE 110
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89106-4355
Mailing Address - Country:US
Mailing Address - Phone:702-894-1410
Mailing Address - Fax:702-384-0479
Practice Address - Street 1:2047 W CHARLESTON BLVD STE 100
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89102-2251
Practice Address - Country:US
Practice Address - Phone:702-384-1410
Practice Address - Fax:702-384-0479
Is Sole Proprietor?:No
Enumeration Date:2007-10-01
Last Update Date:2021-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225000000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotic Fitter