Basic Information
Provider Information
NPI: 1003000241
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: PATTERSON
FirstName: LESLIE
MiddleName: A
NamePrefix:  
NameSuffix:  
Credential: PTA
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 403 PATTERSON RD
Address2:  
City: NEW GALILEE
State: PA
PostalCode: 161414613
CountryCode: US
TelephoneNumber: 7243365659
FaxNumber:  
Practice Location
Address1: 251 GEORGETOWN RD.
Address2:  
City: BEAVER FALLS
State: PA
PostalCode: 15010
CountryCode: US
TelephoneNumber: 7248468200
FaxNumber: 7248472998
Other Information
ProviderEnumerationDate: 08/30/2007
LastUpdateDate: 08/30/2007
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: Y
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
225200000XTE002850LPAY Respiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant 

No ID Information.


Home