| Organization Name: | SALEM SPORTS & SPINE PHYSICAL THEARPY, PC |
| NPI Number: | 1053537407 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | MICHELE LYNN LEASURE (OWNER) |
| Mailing Address: | 56 June Road North Salem |
| State: | NY US |
| Postal Code: | 105600662 |
| Phone Number: | 9146699085 |
| Fax Number: | 9146699095 |
| NPI Enumeration Date: | 04/17/2007 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 2251X0800X |
| License Number: | 018914-1 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | NY |
| Taxonomy Type: | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
| Taxonomy Classification: | Physical Therapist |
| Taxonomy Specialization: | Orthopedic |
| Taxonomy Definition: | |