Provider Demographics
NPI:1992913313
Name:HENRICH, LESLIE REAVER (PT)
Entity type:Individual
Prefix:MRS
First Name:LESLIE
Middle Name:REAVER
Last Name:HENRICH
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:695 EAST MAIN ST
Mailing Address - Street 2:
Mailing Address - City:GALLATIN
Mailing Address - State:TN
Mailing Address - Zip Code:37066-2472
Mailing Address - Country:US
Mailing Address - Phone:615-451-5200
Mailing Address - Fax:615-451-6563
Practice Address - Street 1:695 E MAIN ST
Practice Address - Street 2:
Practice Address - City:GALLATIN
Practice Address - State:TN
Practice Address - Zip Code:37066-2472
Practice Address - Country:US
Practice Address - Phone:615-451-5200
Practice Address - Fax:615-451-6563
Is Sole Proprietor?:No
Enumeration Date:2007-05-18
Last Update Date:2012-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNPT 2107 TN174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist