Leslie Pannucci, PT

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

21752 Issued in MD

Practice address

4707 Schley Ave Unit 595F
Braddock Heights, MD 21714-7524

Phone

(240) 490-8093

Fax

(240) 490-8095

NPI assigned

Jan 20, 2016

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

Other names 1

• Leslie Goldman Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1453248000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1453248000000",
    "number": "1922465111",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9722 MOUNT TABOR RD",
            "city": "MIDDLETOWN",
            "state": "MD",
            "postal_code": "217699523",
            "telephone_number": "240-490-8093",
            "fax_number": "240-490-8095"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4707 SCHLEY AVE UNIT 595F",
            "city": "BRADDOCK HEIGHTS",
            "state": "MD",
            "postal_code": "217147524",
            "telephone_number": "240-490-8093",
            "fax_number": "240-490-8095"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PANNUCCI",
        "first_name": "LESLIE",
        "credential": "PT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-01-20",
        "last_updated": "2016-01-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "MD",
            "license": "21752",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "LESLIE",
            "last_name": "GOLDMAN",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

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• All providers in Braddock Heights, MD
• Physical Therapist in Maryland

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 20, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.