Provider Demographics
NPI:1275561615
Name:MENSCH, MICHELE LEIGH (ATC,CSCS,CKTP)
Entity Type:Individual
Prefix:MS
First Name:MICHELE
Middle Name:LEIGH
Last Name:MENSCH
Suffix:
Gender:F
Credentials:ATC,CSCS,CKTP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 407
Mailing Address - Street 2:
Mailing Address - City:MORICHES
Mailing Address - State:NY
Mailing Address - Zip Code:11955-0407
Mailing Address - Country:US
Mailing Address - Phone:631-838-8113
Mailing Address - Fax:
Practice Address - Street 1:100 LONGWOOD RD
Practice Address - Street 2:
Practice Address - City:MIDDLE ISLAND
Practice Address - State:NY
Practice Address - Zip Code:11953-2056
Practice Address - Country:US
Practice Address - Phone:631-345-9260
Practice Address - Fax:631-345-5265
Is Sole Proprietor?:No
Enumeration Date:2006-06-28
Last Update Date:2024-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0004782255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer