Provider Demographics
NPI:1245634237
Name:SEGELOV, LEAH (PT)
Entity type:Individual
Prefix:
First Name:LEAH
Middle Name:
Last Name:SEGELOV
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:244 5TH AVE STE L289
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10001-7604
Mailing Address - Country:US
Mailing Address - Phone:646-505-9545
Mailing Address - Fax:646-585-9383
Practice Address - Street 1:32 UNION SQ E STE 411
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10003-3245
Practice Address - Country:US
Practice Address - Phone:646-505-9545
Practice Address - Fax:646-585-9383
Is Sole Proprietor?:No
Enumeration Date:2014-10-20
Last Update Date:2020-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY013735225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist