Healthcare Provider Details

I. General information

NPI: 1467591388
Provider Name (Legal Business Name): MICHELE LYNN LEASURE P.T., OCS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MICHELE LEASURE ALTEMUS P.T., OCS

II. Dates (important events)

Enumeration Date: 02/06/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

56 JUNE ROAD
NORTH SALEM NY
10560
US

IV. Provider business mailing address

PO BOX 662
NORTH SALEM NY
10560-0662
US

V. Phone/Fax

Practice location:
  • Phone: 914-669-9085
  • Fax: 914-669-9095
Mailing address:
  • Phone: 914-669-9085
  • Fax: 914-669-9095

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number018914-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: