Provider Demographics
NPI:1164676243
Name:APPLETON, MAIDA L (RPT)
Entity Type:Individual
Prefix:
First Name:MAIDA
Middle Name:L
Last Name:APPLETON
Suffix:
Gender:F
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10711 COMMONS RD
Mailing Address - Street 2:
Mailing Address - City:REMSEN
Mailing Address - State:NY
Mailing Address - Zip Code:13438-4012
Mailing Address - Country:US
Mailing Address - Phone:315-831-3300
Mailing Address - Fax:
Practice Address - Street 1:130 BROOKLEY RD
Practice Address - Street 2:
Practice Address - City:ROME
Practice Address - State:NY
Practice Address - Zip Code:13441-4300
Practice Address - Country:US
Practice Address - Phone:315-533-1150
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-11-16
Last Update Date:2008-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY010180-12251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics