Provider Demographics
NPI:1912961368
Name:SYMULESKI, LEANNE MARIE (DPT)
Entity Type:Individual
Prefix:
First Name:LEANNE
Middle Name:MARIE
Last Name:SYMULESKI
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:LEANNE
Other - Middle Name:MARIE
Other - Last Name:LEFKOWSKI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MPT
Mailing Address - Street 1:334 MAIN ST
Mailing Address - Street 2:STE 1
Mailing Address - City:DICKSON CITY
Mailing Address - State:PA
Mailing Address - Zip Code:18519-1668
Mailing Address - Country:US
Mailing Address - Phone:570-307-1769
Mailing Address - Fax:570-307-1771
Practice Address - Street 1:7 CARNEGIE PLZ
Practice Address - Street 2:
Practice Address - City:CHERRY HILL
Practice Address - State:NJ
Practice Address - Zip Code:08003-1000
Practice Address - Country:US
Practice Address - Phone:877-407-3422
Practice Address - Fax:877-407-4329
Is Sole Proprietor?:No
Enumeration Date:2006-04-13
Last Update Date:2015-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT012827L174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA032043Q69Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER