Provider Demographics
NPI:1265030076
Name:LECLAIR, CASEY ROBERT (DPT, PT)
Entity Type:Individual
Prefix:DR
First Name:CASEY
Middle Name:ROBERT
Last Name:LECLAIR
Suffix:
Gender:M
Credentials:DPT, PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:135 S PERU ST
Mailing Address - Street 2:
Mailing Address - City:PLATTSBURGH
Mailing Address - State:NY
Mailing Address - Zip Code:12901-4706
Mailing Address - Country:US
Mailing Address - Phone:518-563-7777
Mailing Address - Fax:
Practice Address - Street 1:135 S PERU ST
Practice Address - Street 2:
Practice Address - City:PLATTSBURGH
Practice Address - State:NY
Practice Address - Zip Code:12901-4706
Practice Address - Country:US
Practice Address - Phone:518-563-7777
Practice Address - Fax:518-563-7770
Is Sole Proprietor?:No
Enumeration Date:2020-10-14
Last Update Date:2020-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY046304-01208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation