Provider Demographics
NPI:1487603908
Name:SURTEES, LESLEY C (PT)
Entity type:Individual
Prefix:
First Name:LESLEY
Middle Name:C
Last Name:SURTEES
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7985 BAINBROOK DR
Mailing Address - Street 2:
Mailing Address - City:CHAGRIN FALLS
Mailing Address - State:OH
Mailing Address - Zip Code:44023-4871
Mailing Address - Country:US
Mailing Address - Phone:440-519-6914
Mailing Address - Fax:
Practice Address - Street 1:3755 ORANGE PL
Practice Address - Street 2:
Practice Address - City:BEACHWOOD
Practice Address - State:OH
Practice Address - Zip Code:44122-4455
Practice Address - Country:US
Practice Address - Phone:216-825-0203
Practice Address - Fax:216-825-0205
Is Sole Proprietor?:No
Enumeration Date:2006-05-10
Last Update Date:2014-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPT008874225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist