Individual
LESLIE COREEN BLACKWELL
Active
Individual
LESLIE COREEN BLACKWELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
P.T.
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
2305203971
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
010092205
—
VA
01
—
192295
ANTHEM PT
VA
01
—
258462
SOUTHERN HEALTH
VA
01
—
540885859
MULTIPLAN
VA
01
—
98999
OPTIMA HEALTH
VA
Enumeration date
06/04/2006
Last updated
02/01/2013
Update your record
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