1245322080 NPI number — MS. LESLIE CHEREIS COLEMAN PTA FI

Table of content: MS. LESLIE CHEREIS COLEMAN PTA FI (NPI 1245322080)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1245322080 NPI number — MS. LESLIE CHEREIS COLEMAN PTA FI

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
COLEMAN
Provider First Name:
LESLIE
Provider Middle Name:
CHEREIS
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
PTA FI
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1245322080
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3915 GOLDEN VALLEY ROAD
Provider Second Line Business Mailing Address:
COURAGE CENTER
Provider Business Mailing Address City Name:
GOLDEN VALLEY
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
55422-4298
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
763-520-0369
Provider Business Mailing Address Fax Number:
763-520-0392

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3915 GOLDEN VALLEY ROAD
Provider Second Line Business Practice Location Address:
COURAGE CENTER
Provider Business Practice Location Address City Name:
GOLDEN VALLEY
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
55422-4298
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
763-520-0369
Provider Business Practice Location Address Fax Number:
763-520-0355
Provider Enumeration Date:
09/29/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225200000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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