Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251G0304X | Physical Therapist - Geriatrics | PTL-1384 | CO |
NPI | 1346559655 |
---|---|
Provider Name | Mrs. Leslie Kim Roy |
First Address | Livermore, CO 80536-7686 |
Second Address | Thornton, CO 80241-3933 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/10/2010 |
Last Update Date | 04/10/2010 |