Provider Demographics
NPI:1619121126
Name:FURLONG, AMY JEANNE (PT)
Entity Type:Individual
Prefix:MRS
First Name:AMY
Middle Name:JEANNE
Last Name:FURLONG
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MISS
Other - First Name:AMY
Other - Middle Name:JEANNE
Other - Last Name:LESKOVAR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:160 LARK ST
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:NY
Mailing Address - Zip Code:12210-1426
Mailing Address - Country:US
Mailing Address - Phone:518-465-5081
Mailing Address - Fax:518-465-5081
Practice Address - Street 1:127 BLOOMINGROVE DR.
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:NY
Practice Address - Zip Code:12180
Practice Address - Country:US
Practice Address - Phone:518-233-0544
Practice Address - Fax:518-233-0703
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-11
Last Update Date:2013-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY010960-12251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics