Leslie Diane Wilson, PT in Southaven, MS - Medicare Physical Therapist In Private Practice Provider

Leslie Diane Wilson, PT is a medicare enrolled "Physical Therapist" provider in Southaven, Mississippi. She went to Northeastern Ohio University College Of Medicine and graduated in 2012 and has 14 years of diverse experience with area of expertise as Physical Therapist In Private Practice. She is a member of the group practice Mark R. Grubb, Md, Inc. and her current practice location is 3451 Goodman Rd E Ste 108, Southaven, Mississippi. You can reach out to her office (for appointments etc.) via phone at (662) 890-6953.

Leslie Diane Wilson is licensed to practice in Mississippi (license number PT5223) and she also participates in the medicare program. She accepts medicare assignments (which means she accepts the Medicare-approved amount; you will not be billed for any more than the Medicare deductible and coinsurance) and her NPI Number is 1639424799.

Contact Information

	Leslie Diane Wilson, PT
	3451 Goodman Rd E Ste 108, Southaven, MS 38672-9305
	(662) 890-6953
	(662) 890-6954

Map and Direction

Healthcare Provider's Profile

Full Name	Leslie Diane Wilson
Gender	Female
Speciality	Physical Therapist In Private Practice
Experience	14 Years
Location	3451 Goodman Rd E Ste 108, Southaven, Mississippi
Accepts Medicare Assignments	Yes. She accepts the Medicare-approved amount; you will not be billed for any more than the Medicare deductible and coinsurance.

Medical Education and Training:

Leslie Diane Wilson attended and graduated from Northeastern Ohio University College Of Medicine in 2012

NPI Data:

NPI Number: 1639424799
Provider Enumeration Date: 07/16/2012
Last Update Date: 03/25/2025

Medicare PECOS Information:

PECOS PAC ID: 7012163066
Enrollment ID: I20181031003054

Medical Identifiers

Medical identifiers for Leslie Diane Wilson such as npi, medicare ID, medicare PIN, medicaid, etc.

Identifier	Type	State	Issuer
1639424799	NPI	-	NPPES
0317629	Medicaid	OH

Medical Taxonomies and Licenses

Taxonomy	Type	License (State)	Status
225100000X	Physical Therapist	PT017702 (Ohio)	Secondary
2251X0800X	Physical Therapist - Orthopedic	PT017702 (Ohio)	Secondary
225100000X	Physical Therapist	PT5223 (Mississippi)	Primary

Group Practice Association

Group Practice Name	Group PECOS PAC ID	No. of Members
Mark R. Grubb, Md, Inc.	4880590413	16

Medicare Reassignments

Some practitioners may not bill the customers directly but medicare billing happens through clinics / group practice / hospitals where the provider works. Medicare reassignment of benefits is a mechanism by which practitioners allow third parties to bill and receive payment for medicare services performed by them. Leslie Diane Wilson allows following entities to bill medicare on her behalf.

Provider Name	Northern Ohio Medical Specialists, Llc
Provider Type	Part B Supplier - Clinic/group Practice
Provider Identifiers	NPI Number: 1225085855 PECOS PAC ID: 2769386192 Enrollment ID: O20031126000214

Provider Name	Beacon Orthopaedics & Sports Medicine Ltd
Provider Type	Part B Supplier - Clinic/group Practice
Provider Identifiers	NPI Number: 1386670065 PECOS PAC ID: 0345136412 Enrollment ID: O20040225000690

Provider Name	Ohio Luna Care Physical Therapy Llc
Provider Type	Part B Supplier - Physical/occupational Therapy Group In Private Practice
Provider Identifiers	NPI Number: 1285244996 PECOS PAC ID: 6204256696 Enrollment ID: O20201023002938

Provider Name	Mark R. Grubb, Md, Inc.
Provider Type	Part B Supplier - Clinic/group Practice
Provider Identifiers	NPI Number: 1033988928 PECOS PAC ID: 4880590413 Enrollment ID: O20240917000749

Medicare Part D Prescriber Enrollment

Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. Leslie Diane Wilson is enrolled with medicare and thus, if eligible, can prescribe medicare part D drugs to patients with medicare part D benefits.

Mailing Address and Practice Location

Mailing Address	Practice Location Address
Leslie Diane Wilson, PT 800 Crescent Centre Dr Ste 600, Franklin, TN 37067-7286 Ph: (615) 373-1350	Leslie Diane Wilson, PT 3451 Goodman Rd E Ste 108, Southaven, MS 38672-9305 Ph: (662) 890-6953

Reviews and Comments

Physical Therapist in Southaven, MS

Robert Heath Wylie, Physical Therapist Medicare: Not Enrolled in Medicare Practice Location: 7545 Airways Blvd, Southaven, MS 38671 Phone: 901-759-3208
Parker P Haberstroh, Physical Therapist Medicare: Accepting Medicare Assignments Practice Location: 1100 Church Rd W Ste 112, Southaven, MS 38671 Phone: 662-548-3650 Fax: 662-654-8029
Maura Eileen Hickey, PT, DPT Physical Therapist Medicare: Not Enrolled in Medicare Practice Location: 7111 Southcrest Pkwy Ste 105, Southaven, MS 38671 Phone: 901-261-2506 Fax: 901-261-2590
Michael Newton Phillips, PT Physical Therapist Medicare: Not Enrolled in Medicare Practice Location: 3451 Goodman Rd E Ste 108, Southaven, MS 38672 Phone: 662-890-6953
Mrs. Deborah Jill Patton, P.T. Physical Therapist Medicare: Accepting Medicare Assignments Practice Location: 5271 Getwell Rd, Southaven, MS 38672 Phone: 662-510-5694
Mrs. Tara Elaine Burt, PT, DPT Physical Therapist Medicare: Not Enrolled in Medicare Practice Location: 7900 Airways Blvd. Building A, Suite 2, Southaven, MS 38671 Phone: 662-536-4096 Fax: 662-536-4099
Ms. Jerrica Thomas, Physical Therapist Medicare: Not Enrolled in Medicare Practice Location: 7545 Airways Blvd, Southaven, MS 38671 Phone: 901-759-3208

Leslie Diane Wilson, PT - Medicare Physical Therapist in Southaven, MS