Provider Demographics
NPI:1245836618
Name:RIVERA, LESLEY LINDA (PT, DPT)
Entity type:Individual
Prefix:
First Name:LESLEY
Middle Name:LINDA
Last Name:RIVERA
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:LESLEY
Other - Middle Name:LINDA
Other - Last Name:HICKS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:21255 TRAIL RDG
Mailing Address - Street 2:
Mailing Address - City:YORBA LINDA
Mailing Address - State:CA
Mailing Address - Zip Code:92886-7806
Mailing Address - Country:US
Mailing Address - Phone:909-265-3584
Mailing Address - Fax:
Practice Address - Street 1:21255 TRAIL RDG
Practice Address - Street 2:
Practice Address - City:YORBA LINDA
Practice Address - State:CA
Practice Address - Zip Code:92886-7806
Practice Address - Country:US
Practice Address - Phone:909-265-3584
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-10
Last Update Date:2024-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA299430225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist