Individual
LESLIE J HERMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PT
Contact information
Practice address
01 SAGEBRUSH ST, ISLETA, NM 87022-0000
(505) 869-4863
(505) 869-4572
Mailing address
PO BOX 640, ISLETA, NM 87022-0000
(505) 869-4863
(505) 869-4572
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
1699
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1699
STATE PT LICENSE
NM
Enumeration date
10/04/2006
Last updated
07/08/2007
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