Provider Demographics
NPI:1386630176
Name:LEROUX, MICHELE E (PT)
Entity Type:Individual
Prefix:MRS
First Name:MICHELE
Middle Name:E
Last Name:LEROUX
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 1:417 QUEEN ESTHER DR
Mailing Address - Street 2:
Mailing Address - City:SAYRE
Mailing Address - State:PA
Mailing Address - Zip Code:18840-9367
Mailing Address - Country:US
Mailing Address - Phone:315-244-7027
Mailing Address - Fax:
Practice Address - Street 1:24569 ROUTE 6 STE C
Practice Address - Street 2:
Practice Address - City:TOWANDA
Practice Address - State:PA
Practice Address - Zip Code:18848-8254
Practice Address - Country:US
Practice Address - Phone:570-265-7688
Practice Address - Fax:570-265-7422
Is Sole Proprietor?:No
Enumeration Date:2005-09-27
Last Update Date:2022-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT14827225100000X, 2251P0200X
NY0978925225100000X
PAPT019069225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLY2531OtherBC/BS