Individual
LESLIE PROM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DPT
Contact information
Practice address
1015 W 47TH ST, NORFOLK, VA 23529-0001
(757) 683-7041
Mailing address
1015 W 47TH ST, NORFOLK, VA 23529-0001
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
2305204676
VA
Other
Enumeration date
11/02/2015
Last updated
11/02/2015
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