Provider Demographics
NPI:1851441521
Name:LEETE, MICHELE THOMAS
Entity Type:Individual
Prefix:MRS
First Name:MICHELE
Middle Name:THOMAS
Last Name:LEETE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1312 SE 11TH ST
Mailing Address - Street 2:
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33316-1339
Mailing Address - Country:US
Mailing Address - Phone:954-658-6767
Mailing Address - Fax:
Practice Address - Street 1:550 SE 4TH CT
Practice Address - Street 2:
Practice Address - City:DANIA BEACH
Practice Address - State:FL
Practice Address - Zip Code:33004-4738
Practice Address - Country:US
Practice Address - Phone:954-925-7034
Practice Address - Fax:954-925-7034
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-12
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT 7947225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist