1467591388 NPI number — MICHELE LYNN LEASURE P.T., OCS

Table of content: MICHELE LYNN LEASURE P.T., OCS (NPI 1467591388)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1467591388 NPI number — MICHELE LYNN LEASURE P.T., OCS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LEASURE
Provider First Name:
MICHELE
Provider Middle Name:
LYNN
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
P.T., OCS
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
ALTEMUS
Provider Other First Name:
MICHELE
Provider Other Middle Name:
LEASURE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
P.T., OCS
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1467591388
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 662
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NORTH SALEM
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
10560-0662
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
914-669-9085
Provider Business Mailing Address Fax Number:
914-669-9095

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
56 JUNE ROAD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NORTH SALEM
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10560
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
914-669-9085
Provider Business Practice Location Address Fax Number:
914-669-9095
Provider Enumeration Date:
02/06/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 2251X0800X , with the licence number:  018914-1 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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