Provider Demographics
NPI:1780748905
Name:LEVEILLEE, CYNTHIA LYNN (PT)
Entity type:Individual
Prefix:MRS
First Name:CYNTHIA
Middle Name:LYNN
Last Name:LEVEILLEE
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MISS
Other - First Name:CYNTHIA
Other - Middle Name:LYNN
Other - Last Name:PENNA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3 SOUTH AVE
Mailing Address - Street 2:
Mailing Address - City:ALPLAUS
Mailing Address - State:NY
Mailing Address - Zip Code:12008-1019
Mailing Address - Country:US
Mailing Address - Phone:518-225-5434
Mailing Address - Fax:
Practice Address - Street 1:900 WATERVLIET SHAKER RD
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:NY
Practice Address - Zip Code:12205-1002
Practice Address - Country:US
Practice Address - Phone:518-862-4900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-21
Last Update Date:2018-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY021642225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYPENDINGMedicaid
PENDINGMedicare UPIN
NYPENDINGMedicare ID - Type Unspecified