Provider Demographics
NPI:1235909987
Name:ROSSANO, LAURA ANNE (LMT)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:ANNE
Last Name:ROSSANO
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:37 SEQUOIA DR
Mailing Address - Street 2:
Mailing Address - City:CORAM
Mailing Address - State:NY
Mailing Address - Zip Code:11727-2036
Mailing Address - Country:US
Mailing Address - Phone:347-665-3439
Mailing Address - Fax:
Practice Address - Street 1:4155 VETERANS HWY STE 5
Practice Address - Street 2:
Practice Address - City:RONKONKOMA
Practice Address - State:NY
Practice Address - Zip Code:11779-6063
Practice Address - Country:US
Practice Address - Phone:516-375-0440
Practice Address - Fax:631-939-2407
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-04
Last Update Date:2024-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY026715225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist