Provider Demographics
NPI:1033426218
Name:DONNA LANZA PHYSICAL THERAPY PC
Entity Type:Organization
Organization Name:DONNA LANZA PHYSICAL THERAPY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DONNA
Authorized Official - Middle Name:
Authorized Official - Last Name:LANZA
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:631-332-1779
Mailing Address - Street 1:691 ROUTE 25A
Mailing Address - Street 2:BLDG 15
Mailing Address - City:MILLER PLACE
Mailing Address - State:NY
Mailing Address - Zip Code:11764-2643
Mailing Address - Country:US
Mailing Address - Phone:631-332-1779
Mailing Address - Fax:631-982-5650
Practice Address - Street 1:691 ROUTE 25A
Practice Address - Street 2:BLDG 15
Practice Address - City:MILLER PLACE
Practice Address - State:NY
Practice Address - Zip Code:11764-2643
Practice Address - Country:US
Practice Address - Phone:631-332-1779
Practice Address - Fax:631-982-5650
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-08
Last Update Date:2010-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY14510225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYQ15341OtherEMPIRE BLUE CROSS
NYQ38961Medicare PIN