Individual
LESLIE TERRELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
P.T.
Contact information
Practice address
250 S MCCORMICK ST, PRESCOTT, AZ 86303-4714
(928) 710-1819
(928) 443-9029
Mailing address
630 S BANDIT RIDGE RD, PRESCOTT, AZ 86305-9758
(928) 710-1819
(928) 443-9029
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
4291
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0310230
BCBS
AZ
01
—
1887614
CHAMP VA
AZ
01
—
19139712
SCF OF ARIZONA
AZ
01
—
352947100
US DEPARTMENT OF LABOR
AZ
05
—
456865-001
—
AZ
01
—
7393636
AETNA
AZ
Enumeration date
05/09/2006
Last updated
03/06/2023
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