Provider Demographics
NPI:1467591388
Name:LEASURE, MICHELE LYNN (PT, OCS)
Entity Type:Individual
Prefix:
First Name:MICHELE
Middle Name:LYNN
Last Name:LEASURE
Suffix:
Gender:F
Credentials:PT, OCS
Other - Prefix:
Other - First Name:MICHELE
Other - Middle Name:LEASURE
Other - Last Name:ALTEMUS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT, OCS
Mailing Address - Street 1:PO BOX 662
Mailing Address - Street 2:
Mailing Address - City:NORTH SALEM
Mailing Address - State:NY
Mailing Address - Zip Code:10560-0662
Mailing Address - Country:US
Mailing Address - Phone:914-669-9085
Mailing Address - Fax:914-669-9095
Practice Address - Street 1:56 JUNE ROAD
Practice Address - Street 2:
Practice Address - City:NORTH SALEM
Practice Address - State:NY
Practice Address - Zip Code:10560
Practice Address - Country:US
Practice Address - Phone:914-669-9085
Practice Address - Fax:914-669-9095
Is Sole Proprietor?:No
Enumeration Date:2007-02-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY018914-12251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYQ5W6W1Medicare ID - Type Unspecified