Provider Demographics
NPI:1104875780
Name:LESUER, KEVIN T (PT)
Entity type:Individual
Prefix:
First Name:KEVIN
Middle Name:T
Last Name:LESUER
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 987
Mailing Address - Street 2:
Mailing Address - City:MIDDLEFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:44062-0987
Mailing Address - Country:US
Mailing Address - Phone:440-632-1007
Mailing Address - Fax:440-574-7254
Practice Address - Street 1:11850 MAYFIELD RD STE 1
Practice Address - Street 2:
Practice Address - City:CHARDON
Practice Address - State:OH
Practice Address - Zip Code:44024-8371
Practice Address - Country:US
Practice Address - Phone:440-286-1007
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-09
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPT009428225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist