Provider Demographics
NPI:1235570508
Name:MIGLIACCIO, LYNN ANN (PTA, RN)
Entity Type:Individual
Prefix:
First Name:LYNN
Middle Name:ANN
Last Name:MIGLIACCIO
Suffix:
Gender:F
Credentials:PTA, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7 HANOVER PL
Mailing Address - Street 2:
Mailing Address - City:ROCKVILLE CENTRE
Mailing Address - State:NY
Mailing Address - Zip Code:11570-4201
Mailing Address - Country:US
Mailing Address - Phone:516-766-3020
Mailing Address - Fax:
Practice Address - Street 1:7 HANOVER PL
Practice Address - Street 2:
Practice Address - City:ROCKVILLE CENTRE
Practice Address - State:NY
Practice Address - Zip Code:11570-4201
Practice Address - Country:US
Practice Address - Phone:516-766-3020
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-15
Last Update Date:2013-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY004156225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant