Provider Demographics
NPI:1720284193
Name:VOGEL, LESLIE FAYE (MSPT)
Entity type:Individual
Prefix:
First Name:LESLIE
Middle Name:FAYE
Last Name:VOGEL
Suffix:
Gender:F
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9021 35TH AVE NE
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98115-3614
Mailing Address - Country:US
Mailing Address - Phone:206-526-0542
Mailing Address - Fax:206-526-0542
Practice Address - Street 1:4800 SAND POINT WAY NE
Practice Address - Street 2:W6804
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98105-3901
Practice Address - Country:US
Practice Address - Phone:206-987-3128
Practice Address - Fax:206-987-2409
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT000055152251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAVO5811OtherREGENCE PRACTIONER NUMBER
WA7057870Medicaid