Basic Information
| Provider Information | |||||||||
| NPI: | 1326356288 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | STRAUB | ||||||||
| FirstName: | LESHEA | ||||||||
| MiddleName: | ANN | ||||||||
| NamePrefix: | |||||||||
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| Credential: | LPTA | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | SELBY | ||||||||
| OtherFirstName: | LESHEA | ||||||||
| OtherMiddleName: | ANN | ||||||||
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| OtherCredential: | LPTA | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 81 RIVERWOOD AVE | ||||||||
| Address2: | |||||||||
| City: | WEST FORK | ||||||||
| State: | AR | ||||||||
| PostalCode: | 727742937 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4794096376 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 1112 S 48TH ST | ||||||||
| Address2: | SUITE B | ||||||||
| City: | SPRINGDALE | ||||||||
| State: | AR | ||||||||
| PostalCode: | 727625848 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4797513900 | ||||||||
| FaxNumber: | 4797513011 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/14/2010 | ||||||||
| LastUpdateDate: | 10/21/2021 | ||||||||
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| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | F | ||||||||
| AuthorizedOfficialLastName: | |||||||||
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| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | |||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 10/21/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225200000X | 2459 | AR | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapy Assistant |
No ID Information.