Provider Demographics
NPI:1619177524
Name:LASURE, JENILEE JOY (DPT ATC)
Entity Type:Individual
Prefix:MRS
First Name:JENILEE
Middle Name:JOY
Last Name:LASURE
Suffix:
Gender:F
Credentials:DPT ATC
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:1513 SCALP AVE STE 260
Mailing Address - Street 2:
Mailing Address - City:JOHNSTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:15904-3332
Mailing Address - Country:US
Mailing Address - Phone:814-266-4108
Mailing Address - Fax:814-269-2370
Practice Address - Street 1:1513 SCALP AVE STE 260
Practice Address - Street 2:
Practice Address - City:JOHNSTOWN
Practice Address - State:PA
Practice Address - Zip Code:15904-3332
Practice Address - Country:US
Practice Address - Phone:814-266-4108
Practice Address - Fax:814-269-2370
Is Sole Proprietor?:No
Enumeration Date:2007-07-19
Last Update Date:2019-06-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAPT0187272251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic