Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | PT21647 | FL |
NPI | 1003055732 |
---|---|
Provider Name | Heather Leshane |
First Address | Saint Augustine, FL 32086-5784 |
Second Address | Saint Augustine, FL 32086-5784 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/02/2009 |
Last Update Date | 13/09/2010 |