Provider Demographics
NPI:1164725115
Name:LEIREY, JEAN (PT)
Entity Type:Individual
Prefix:MRS
First Name:JEAN
Middle Name:
Last Name:LEIREY
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:61 CROWN ST
Mailing Address - Street 2:
Mailing Address - City:KINGSTON
Mailing Address - State:NY
Mailing Address - Zip Code:12401-3833
Mailing Address - Country:US
Mailing Address - Phone:845-339-3000
Mailing Address - Fax:
Practice Address - Street 1:781 NEIGHBORHOOD RD
Practice Address - Street 2:
Practice Address - City:LAKE KATRINE
Practice Address - State:NY
Practice Address - Zip Code:12449-5311
Practice Address - Country:US
Practice Address - Phone:845-382-2633
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-12-14
Last Update Date:2010-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY011108-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist