Individual
LESLIE NILSEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
517 GREAT OAKS DR, SUITE 102, MONROE, GA 30655-8211
(770) 207-6624
Mailing address
307 STONE ST, OXFORD, GA 30054-2439
Taxonomy
Speciality
Code
Description
License number
State
2251X0800X
Orthopedic Physical Therapist
Primary
PT009147
GA
Other
Enumeration date
05/17/2007
Last updated
01/18/2008
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