Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251P0200X | Physical Therapist - Pediatrics | 015278-1 | NY |
NPI | 1043529753 |
---|---|
Provider Name | Lainie Baxt |
First Address | Syosset, NY 11791-6108 |
Second Address | Syosset, NY 11791-6108 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 29/09/2010 |
Last Update Date | 29/09/2010 |