Provider Demographics
NPI:1609919885
Name:DALLARA, LESLIE ANN (PT)
Entity type:Individual
Prefix:
First Name:LESLIE
Middle Name:ANN
Last Name:DALLARA
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2685 HEMLOCK FARMS
Mailing Address - Street 2:
Mailing Address - City:HAWLEY
Mailing Address - State:PA
Mailing Address - Zip Code:18428-9091
Mailing Address - Country:US
Mailing Address - Phone:570-629-4921
Mailing Address - Fax:570-629-9221
Practice Address - Street 1:HC 1 BOX 2014
Practice Address - Street 2:
Practice Address - City:TANNERSVILLE
Practice Address - State:PA
Practice Address - Zip Code:18372-9095
Practice Address - Country:US
Practice Address - Phone:570-629-4921
Practice Address - Fax:570-629-9221
Is Sole Proprietor?:No
Enumeration Date:2007-02-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT018002225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist