Provider Demographics
NPI:1285845560
Name:RUSSEK, LESLIE N (PT)
Entity Type:Individual
Prefix:PROF
First Name:LESLIE
Middle Name:N
Last Name:RUSSEK
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 1:59 MAIN ST
Mailing Address - Street 2:CANTON-POTSDAM HOSPITAL PHYSICAL THERAPY DEPT
Mailing Address - City:POTSDAM
Mailing Address - State:NY
Mailing Address - Zip Code:13676-2148
Mailing Address - Country:US
Mailing Address - Phone:315-261-5460
Mailing Address - Fax:
Practice Address - Street 1:59 MAIN ST
Practice Address - Street 2:CANTON-POTSDAM HOSPITAL PHYSICAL THERAPY DEPT
Practice Address - City:POTSDAM
Practice Address - State:NY
Practice Address - Zip Code:13676-2148
Practice Address - Country:US
Practice Address - Phone:315-261-5460
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY017154-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist