Provider Demographics
NPI:1174922207
Name:DIAZ, LESLIE ANN (PT, DPT)
Entity type:Individual
Prefix:DR
First Name:LESLIE
Middle Name:ANN
Last Name:DIAZ
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:DR
Other - First Name:LESLIE
Other - Middle Name:ANN
Other - Last Name:SPINELLA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT, DPT
Mailing Address - Street 1:4201 CARTNAL AVE
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33618-8600
Mailing Address - Country:US
Mailing Address - Phone:305-301-0688
Mailing Address - Fax:
Practice Address - Street 1:14813 N DALE MABRY HWY STE 720
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33618-2027
Practice Address - Country:US
Practice Address - Phone:813-964-5982
Practice Address - Fax:813-964-5618
Is Sole Proprietor?:No
Enumeration Date:2014-08-14
Last Update Date:2020-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL29336225100000X, 2251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1205098993Medicare UPIN