Provider Demographics
NPI:1699538827
Name:SHIELDS, LESLIE ALLISON (DPT)
Entity type:Individual
Prefix:
First Name:LESLIE
Middle Name:ALLISON
Last Name:SHIELDS
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3740 BOILING SPRINGS RD # 127
Mailing Address - Street 2:
Mailing Address - City:BOILING SPRINGS
Mailing Address - State:SC
Mailing Address - Zip Code:29316-5716
Mailing Address - Country:US
Mailing Address - Phone:864-702-8090
Mailing Address - Fax:
Practice Address - Street 1:160 FARMHOUSE RD
Practice Address - Street 2:
Practice Address - City:CAMPOBELLO
Practice Address - State:SC
Practice Address - Zip Code:29322-9344
Practice Address - Country:US
Practice Address - Phone:864-702-8090
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-31
Last Update Date:2024-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC4909225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist