Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | PT014947 | OH |
N | 2251H1200X | Hand | ||
N | 2251N0400X | Physical Therapist - Neurology | ||
N | 2251S0007X | Physical Therapist - Sports | ||
N | 2251X0800X | Physical Therapist - Orthopedic |
NPI | 1760891428 |
---|---|
Provider Name | Ms. Lauren Elizabeth Perisa-Cicchillo |
First Address | Warren, OH 44484-3073 |
Second Address | Warren, OH 44484-3073 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 07/08/2014 |
Last Update Date | 08/12/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0109240 | (05) | OH |
H369820 | (02) | OH |