Active NPI
Leslie Michele Mancill, PTA
- Physical Therapy Assistant
- Friendswood, TX
National Provider Identifier
1801417035
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapy Assistant
- License
- 2029429
- Practice address
- 104 E Heritage Dr
Friendswood, TX 77546-3854 - Phone
- (281) 993-2009
- Fax
- (281) 993-2007
- NPI assigned
- Apr 28, 2020
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapy Assistant | 225200000X | 2029429 | TX | Primary |
Addresses
Primary practice location
104 E Heritage Dr
Friendswood, TX 77546-3854
Mailing address
PO Box 618
Santa Fe, TX 77510-0618
Phone (409) 789-3605
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2029429 | TX | MD | Physical Therapy Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1588032000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1588032000000",
"number": "1801417035",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 618",
"city": "SANTA FE",
"state": "TX",
"postal_code": "775100618",
"telephone_number": "409-789-3605"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "104 E HERITAGE DR",
"city": "FRIENDSWOOD",
"state": "TX",
"postal_code": "775463854",
"telephone_number": "281-993-2009",
"fax_number": "281-993-2007"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MANCILL",
"first_name": "LESLIE",
"middle_name": "MICHELE",
"name_prefix": "Mrs.",
"credential": "PTA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2020-04-28",
"last_updated": "2020-04-28",
"certification_date": "2020-04-28",
"status": "A"
},
"taxonomies": [
{
"code": "225200000X",
"taxonomy_group": "",
"desc": "Physical Therapy Assistant",
"state": "TX",
"license": "2029429",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Friendswood, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 28, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.