Provider Demographics
NPI:1144431388
Name:LAWLISS-CORRADO, JODILYNN DORA (PT)
Entity type:Individual
Prefix:
First Name:JODILYNN
Middle Name:DORA
Last Name:LAWLISS-CORRADO
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 1:215 BENMONT AVE
Mailing Address - Street 2:SUITE B
Mailing Address - City:BENNINGTON
Mailing Address - State:VT
Mailing Address - Zip Code:05201-1865
Mailing Address - Country:US
Mailing Address - Phone:802-442-9006
Mailing Address - Fax:802-442-9006
Practice Address - Street 1:215 BENMONT AVE
Practice Address - Street 2:SUITE B
Practice Address - City:BENNINGTON
Practice Address - State:VT
Practice Address - Zip Code:05201-1865
Practice Address - Country:US
Practice Address - Phone:802-442-9006
Practice Address - Fax:802-442-9006
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-26
Last Update Date:2008-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT040-0002639225100000X
NY012230225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist