Individual
LESLIE DEREPENTIGNY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
3636 10TH AVE N, ST PETERSBURG, FL 33713-6528
(727) 323-3611
Mailing address
10901 BRIGHTON BAY BLVD NE, ST PETERSBURG, FL 33716-3446
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
29223
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
78311
—
FL
Enumeration date
05/05/2020
Last updated
05/05/2020
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