Provider Demographics
NPI:1861614422
Name:GEORGE, LESLIE KARA (ATC, MS)
Entity type:Individual
Prefix:MRS
First Name:LESLIE
Middle Name:KARA
Last Name:GEORGE
Suffix:
Gender:F
Credentials:ATC, MS
Other - Prefix:MISS
Other - First Name:LESLIE
Other - Middle Name:KARA
Other - Last Name:LYNCH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ATC, MS
Mailing Address - Street 1:17536 W OCOTILLO RD
Mailing Address - Street 2:
Mailing Address - City:WADDELL
Mailing Address - State:AZ
Mailing Address - Zip Code:85355-9725
Mailing Address - Country:US
Mailing Address - Phone:623-536-7199
Mailing Address - Fax:
Practice Address - Street 1:14802 W WIGWAM BLVD
Practice Address - Street 2:
Practice Address - City:GOODYEAR
Practice Address - State:AZ
Practice Address - Zip Code:85338-8231
Practice Address - Country:US
Practice Address - Phone:623-932-7200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer