Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | 18500 | NY |
N | 2251P0200X | Physical Therapist - Pediatrics | 18500 | NY |
NPI | 1114171394 |
---|---|
Provider Name | Stacey Lamoreaux |
First Address | Lynbrook, NY 11563-2429 |
Second Address | Lynbrook, NY 11563-2429 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 13/11/2008 |
Last Update Date | 13/11/2008 |