Provider Demographics
NPI:1114263555
Name:ZIETSMAN, LAUREN KATHRYN (PT)
Entity Type:Individual
Prefix:
First Name:LAUREN
Middle Name:KATHRYN
Last Name:ZIETSMAN
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:532 MURRAY HILL RD
Mailing Address - Street 2:
Mailing Address - City:VESTAL
Mailing Address - State:NY
Mailing Address - Zip Code:13850-3824
Mailing Address - Country:US
Mailing Address - Phone:315-396-4092
Mailing Address - Fax:
Practice Address - Street 1:1868 E BEECHER HILL RD
Practice Address - Street 2:
Practice Address - City:OWEGO
Practice Address - State:NY
Practice Address - Zip Code:13827-3815
Practice Address - Country:US
Practice Address - Phone:877-426-3307
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-12-12
Last Update Date:2018-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0358342251P0200X
NY035834-12251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics
No2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic