Provider Demographics
NPI:1326571571
Name:ZBOCK, LAURIE (LMT)
Entity Type:Individual
Prefix:
First Name:LAURIE
Middle Name:
Last Name:ZBOCK
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:LAURIE
Other - Middle Name:
Other - Last Name:BONO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3438 STATE ROUTE 12B
Mailing Address - Street 2:
Mailing Address - City:BOUCKVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:13310-1804
Mailing Address - Country:US
Mailing Address - Phone:315-750-0737
Mailing Address - Fax:
Practice Address - Street 1:7320 ROUTE 20
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:NY
Practice Address - Zip Code:13402
Practice Address - Country:US
Practice Address - Phone:315-750-0737
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-05
Last Update Date:2017-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY017721225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist