Healthcare Provider Details

I. General information

NPI: 1306629316
Provider Name (Legal Business Name): TAYLOR LEE LEONETTE DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/15/2023
Last Update Date: 08/15/2023
Certification Date: 08/15/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 HOSPITAL RD STE 112
EAST PATCHOGUE NY
11772-8811
US

IV. Provider business mailing address

16 MAYBROOK RD STE L
CAMPBELL HALL NY
10916-2741
US

V. Phone/Fax

Practice location:
  • Phone: 631-456-5512
  • Fax: 631-456-5514
Mailing address:
  • Phone: 845-636-4344
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number050833
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: