Provider Demographics
NPI:1871978882
Name:MIDLICK, LESLIE BIDDLE (PT)
Entity type:Individual
Prefix:
First Name:LESLIE
Middle Name:BIDDLE
Last Name:MIDLICK
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:LESLIE
Other - Middle Name:ANNETTE
Other - Last Name:MIDLICK
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PT
Mailing Address - Street 1:778 SCOGIN DR
Mailing Address - Street 2:
Mailing Address - City:MONTICELLO
Mailing Address - State:AR
Mailing Address - Zip Code:71655-5729
Mailing Address - Country:US
Mailing Address - Phone:870-460-3540
Mailing Address - Fax:870-460-4860
Practice Address - Street 1:778 SCOGIN DR
Practice Address - Street 2:
Practice Address - City:MONTICELLO
Practice Address - State:AR
Practice Address - Zip Code:71655-5729
Practice Address - Country:US
Practice Address - Phone:870-460-3549
Practice Address - Fax:870-460-3540
Is Sole Proprietor?:No
Enumeration Date:2015-07-21
Last Update Date:2022-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNPT0000006853225100000X
MSPT1443225100000X
ARPT5113225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist