Wilson, Leslie Diane
Wilson, Leslie Diane is an individual health care provider with primary practice located at 3451 Goodman Rd E Ste 108 , Southaven MS 38672-9305. She recently has 2 registered licenses in different health care specialties including Respiratory, Developmental, Rehabilitative and Restorative Service Providers / Physical Therapist, Respiratory, Developmental, Rehabilitative and Restorative Service Providers / Orthopedic. Respiratory, Developmental, Rehabilitative and Restorative Service Providers / Physical Therapist is her primary health care specialty. Wilson, Leslie Diane can be contacted via phone (662) 890-6953.Contact Information
Primary practice address
3451 Goodman Rd E Ste 108
Southaven MS 38672-9305
Phone: (662) 890-6953
Fax: (662) 890-6954
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Respiratory, Developmental, Rehabilitative and Restorative Service Providers / Physical Therapist | 225100000X | PT017702 | Ohio |
| Respiratory, Developmental, Rehabilitative and Restorative Service Providers / Orthopedic | 2251X0800X | PT017702 | Ohio |
| Respiratory, Developmental, Rehabilitative and Restorative Service Providers / Physical Therapist | 225100000X | PT5223 | Mississippi |
Profile Details
| NPI number | 1639424799 |
|---|---|
| LBN Legal business name | Wilson, Leslie Diane |
| Credentials | Physical Therapist (PT) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Jul 16th, 2012 |
| Last updated | Mar 25th, 2025 - about last year |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1639424799 | NPPES |
| Ohio | MEDICAID | 0317629 |
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