Provider Demographics
NPI:1972617983
Name:SPRAGUE, LESLIE SUE (RPT)
Entity type:Individual
Prefix:MRS
First Name:LESLIE
Middle Name:SUE
Last Name:SPRAGUE
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 1:7027 W BROWARD BLVD # 251
Mailing Address - Street 2:
Mailing Address - City:PLANTATION
Mailing Address - State:FL
Mailing Address - Zip Code:33317-2208
Mailing Address - Country:US
Mailing Address - Phone:954-791-9328
Mailing Address - Fax:954-791-9328
Practice Address - Street 1:7027 W BROWARD BLVD # 251
Practice Address - Street 2:
Practice Address - City:PLANTATION
Practice Address - State:FL
Practice Address - Zip Code:33317-2208
Practice Address - Country:US
Practice Address - Phone:954-791-9328
Practice Address - Fax:954-791-9328
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT0003038225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist