Provider Demographics
NPI:1891194270
Name:LESLIE JEANNITON PHYSICAL THERAPIST P.C.
Entity Type:Organization
Organization Name:LESLIE JEANNITON PHYSICAL THERAPIST P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPY
Authorized Official - Prefix:MRS
Authorized Official - First Name:LESLIE
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:JEANNITON
Authorized Official - Suffix:
Authorized Official - Credentials:MS,DPT
Authorized Official - Phone:516-374-7477
Mailing Address - Street 1:172 NOYE LN
Mailing Address - Street 2:
Mailing Address - City:WOODMERE
Mailing Address - State:NY
Mailing Address - Zip Code:11598-1837
Mailing Address - Country:US
Mailing Address - Phone:516-374-7477
Mailing Address - Fax:516-374-7477
Practice Address - Street 1:172 NOYE LN
Practice Address - Street 2:
Practice Address - City:WOODMERE
Practice Address - State:NY
Practice Address - Zip Code:11598-1837
Practice Address - Country:US
Practice Address - Phone:516-374-7477
Practice Address - Fax:516-374-7477
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-21
Last Update Date:2014-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY009516-1252Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency