Provider Demographics
NPI:1992915821
Name:RICHARDT, LESLEY DENISE (RPTA)
Entity type:Individual
Prefix:MRS
First Name:LESLEY
Middle Name:DENISE
Last Name:RICHARDT
Suffix:
Gender:F
Credentials:RPTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5418 REDBUD DR
Mailing Address - Street 2:
Mailing Address - City:SAND SPRINGS
Mailing Address - State:OK
Mailing Address - Zip Code:74063-3265
Mailing Address - Country:US
Mailing Address - Phone:918-520-2756
Mailing Address - Fax:918-419-2086
Practice Address - Street 1:5418 REDBUD DR
Practice Address - Street 2:
Practice Address - City:SAND SPRINGS
Practice Address - State:OK
Practice Address - Zip Code:74063-3265
Practice Address - Country:US
Practice Address - Phone:918-520-2756
Practice Address - Fax:918-419-2086
Is Sole Proprietor?:No
Enumeration Date:2007-05-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK946225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant