Provider Demographics
NPI:1356818611
Name:LIANTONIO, PATRICIA DAWN (LMT)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:DAWN
Last Name:LIANTONIO
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 1:449 MAIN ST APT 1
Mailing Address - Street 2:
Mailing Address - City:GREENPORT
Mailing Address - State:NY
Mailing Address - Zip Code:11944-1498
Mailing Address - Country:US
Mailing Address - Phone:631-407-5040
Mailing Address - Fax:
Practice Address - Street 1:449 MAIN STREET
Practice Address - Street 2:
Practice Address - City:GREENPORT
Practice Address - State:NY
Practice Address - Zip Code:11944
Practice Address - Country:US
Practice Address - Phone:631-407-5040
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-25
Last Update Date:2018-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY00699-3225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty