Provider Demographics
NPI:1235304577
Name:GAMMON, JOHN SCHUYLER II (LMT)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:SCHUYLER
Last Name:GAMMON
Suffix:II
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:488 BULL RUN RD
Mailing Address - Street 2:
Mailing Address - City:LISBON
Mailing Address - State:NY
Mailing Address - Zip Code:13658-3257
Mailing Address - Country:US
Mailing Address - Phone:315-393-4204
Mailing Address - Fax:
Practice Address - Street 1:488 BULL RUN RD
Practice Address - Street 2:
Practice Address - City:LISBON
Practice Address - State:NY
Practice Address - Zip Code:13658-3257
Practice Address - Country:US
Practice Address - Phone:315-393-4204
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-28
Last Update Date:2008-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0176961225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist