Provider Demographics
NPI:1942539515
Name:BUCEY, LESLEY ANNE (PT)
Entity Type:Individual
Prefix:
First Name:LESLEY
Middle Name:ANNE
Last Name:BUCEY
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:LESLEY
Other - Middle Name:ANNE
Other - Last Name:CUNNINGHAM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:510 W MAIN ST STE B
Mailing Address - Street 2:
Mailing Address - City:CANFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:44406-1454
Mailing Address - Country:US
Mailing Address - Phone:330-702-0110
Mailing Address - Fax:330-702-0510
Practice Address - Street 1:4329 MAHONING AVE NW STE B
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:OH
Practice Address - Zip Code:44483-1974
Practice Address - Country:US
Practice Address - Phone:330-847-7819
Practice Address - Fax:330-847-8192
Is Sole Proprietor?:No
Enumeration Date:2009-12-10
Last Update Date:2010-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPT.010760225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH3030802Medicaid
OH4148822Medicare PIN