Provider Demographics
NPI:1235431693
Name:MUNSON, KAREN MARY (PT)
Entity Type:Individual
Prefix:MS
First Name:KAREN
Middle Name:MARY
Last Name:MUNSON
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MISS
Other - First Name:KAREN
Other - Middle Name:MARY
Other - Last Name:LAZIO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:131 DRUMLIN CT
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:NY
Mailing Address - Zip Code:14513-1863
Mailing Address - Country:US
Mailing Address - Phone:585-425-0085
Mailing Address - Fax:585-289-4499
Practice Address - Street 1:1506 ROUTE 21
Practice Address - Street 2:
Practice Address - City:SHORTSVILLE
Practice Address - State:NY
Practice Address - Zip Code:14548-9502
Practice Address - Country:US
Practice Address - Phone:585-289-9647
Practice Address - Fax:585-289-4499
Is Sole Proprietor?:No
Enumeration Date:2010-11-17
Last Update Date:2010-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY9247-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY9247-1OtherNY STATE PHYSICAL THERAPY LICENSE NUMBER