Provider Demographics
NPI:1467605436
Name:LESER, MICHELE CYRAN (MAPT, DPT)
Entity Type:Individual
Prefix:MS
First Name:MICHELE
Middle Name:CYRAN
Last Name:LESER
Suffix:
Gender:F
Credentials:MAPT, DPT
Other - Prefix:MS
Other - First Name:MICHELE
Other - Middle Name:LYN
Other - Last Name:CYRAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA, PT
Mailing Address - Street 1:3 BONNIWELL PL
Mailing Address - Street 2:
Mailing Address - City:BAY SHORE
Mailing Address - State:NY
Mailing Address - Zip Code:11706-7803
Mailing Address - Country:US
Mailing Address - Phone:516-459-7904
Mailing Address - Fax:631-328-1833
Practice Address - Street 1:3 BONNIWELL PL
Practice Address - Street 2:
Practice Address - City:BAY SHORE
Practice Address - State:NY
Practice Address - Zip Code:11706-7803
Practice Address - Country:US
Practice Address - Phone:516-459-7904
Practice Address - Fax:631-328-1833
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-03
Last Update Date:2019-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY015489-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist