Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251G0304X | Physical Therapist - Geriatrics | 107483 | MO |
N | 2251G0304X | Physical Therapist - Geriatrics | 11-02697 | KS |
NPI | 1093921017 |
---|---|
Provider Name | Leslie Leann Scalzo |
First Address | Kansas City, MO 64149-1255 |
Second Address | Raytown, MO 64138-4414 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/05/2007 |
Last Update Date | 08/07/2007 |