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Individual

LESLIE BLACK

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
PT

Contact information

Practice address
1111 CRATER LAKE AVE, MEDFORD, OR 97504-6241
(541) 732-5037
Mailing address
1111 CRATER LAKE AVE, MEDFORD, OR 97504-6241
(541) 732-5037

Taxonomy

Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
02834
OR

Other

Enumeration date
08/07/2018
Last updated
08/07/2018
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