Leslie Prom, DPT

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

2305204676 Issued in VA

Practice address

1015 W 47TH St
Norfolk, VA 23529-0001

Phone

(757) 683-7041

NPI assigned

Nov 2, 2015

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in VA

Enrollment records 1

Specialty

Physical Therapist in Private Practice

Education

Other, 2004

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Old Dominion UniversityGroup PAC ID 3476770520, 13 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Old Dominion University

  • Physical Therapist
  • Norfolk, VA
  • NPI 1871929729
  Medicare reassignment Care Compare group NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1446422400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1446422400000",
    "number": "1821461682",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1015 W 47TH ST",
            "city": "NORFOLK",
            "state": "VA",
            "postal_code": "235290001"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1015 W 47TH ST",
            "city": "NORFOLK",
            "state": "VA",
            "postal_code": "235290001",
            "telephone_number": "757-683-7041"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PROM",
        "first_name": "LESLIE",
        "credential": "DPT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-11-02",
        "last_updated": "2015-11-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "VA",
            "license": "2305204676",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Brianna Prochnow, COTA
• Margaret Proctor, LAC
• Professional Home Care of Virginia Inc
• Dirk Stanton Proffer, MD
• Progressive Autism Consulting and Therapy
• Promising Peace Home Health Care
• Jennifer Proper, OT
• Prosperity Eating Disorder and Wellness
• Prosperity in-Home Health Care Servicec, LLC
• Crystal Miller Proud, M.D.

• Physical Therapist in Norfolk, VA
• Providers in Norfolk, VA by specialty
• Physical Therapist in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 2, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.