Provider Demographics
NPI:1326635517
Name:CREWS PIRES, LANIE ANN KELSEY (DPT)
Entity Type:Individual
Prefix:
First Name:LANIE ANN
Middle Name:KELSEY
Last Name:CREWS PIRES
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7 CENTER DR
Mailing Address - Street 2:
Mailing Address - City:WHITESTONE
Mailing Address - State:NY
Mailing Address - Zip Code:11357-1072
Mailing Address - Country:US
Mailing Address - Phone:347-609-5500
Mailing Address - Fax:
Practice Address - Street 1:820 HEMPSTEAD TPKE
Practice Address - Street 2:
Practice Address - City:FRANKLIN SQUARE
Practice Address - State:NY
Practice Address - Zip Code:11010-4339
Practice Address - Country:US
Practice Address - Phone:516-358-8911
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-22
Last Update Date:2020-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY046809225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist