Provider Demographics
NPI:1962520262
Name:LESLIE, SUSAN DENISE (RPT)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:DENISE
Last Name:LESLIE
Suffix:
Gender:F
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16 HERITAGE DR
Mailing Address - Street 2:
Mailing Address - City:ROLLINSFORD
Mailing Address - State:NH
Mailing Address - Zip Code:03869-5102
Mailing Address - Country:US
Mailing Address - Phone:603-749-6122
Mailing Address - Fax:
Practice Address - Street 1:195 DOVER POINT RD
Practice Address - Street 2:
Practice Address - City:DOVER
Practice Address - State:NH
Practice Address - Zip Code:03820-4612
Practice Address - Country:US
Practice Address - Phone:603-742-2612
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH1076225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist