Healthcare Provider Details

I. General information

NPI: 1902106552
Provider Name (Legal Business Name): JESSICA KATHRYN LEBDUSKA MS, DPT, PT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/29/2010
Last Update Date: 09/16/2026
Certification Date: 09/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

71 OCEAN PKWY APT 6J
BROOKLYN NY
11218-1832
US

IV. Provider business mailing address

71 OCEAN PKWY APT 6J
BROOKLYN NY
11218-1832
US

V. Phone/Fax

Practice location:
  • Phone: 315-657-7645
  • Fax:
Mailing address:
  • Phone: 315-657-7645
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number62030007
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: