Provider Demographics
NPI:1376856815
Name:MACALUSO, LYNNE (PTA)
Entity Type:Individual
Prefix:MRS
First Name:LYNNE
Middle Name:
Last Name:MACALUSO
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27 ACKLEY AVE
Mailing Address - Street 2:
Mailing Address - City:MALVERNE
Mailing Address - State:NY
Mailing Address - Zip Code:11565-1920
Mailing Address - Country:US
Mailing Address - Phone:516-887-2822
Mailing Address - Fax:
Practice Address - Street 1:27 ACKLEY AVE
Practice Address - Street 2:
Practice Address - City:MALVERNE
Practice Address - State:NY
Practice Address - Zip Code:11565-1920
Practice Address - Country:US
Practice Address - Phone:516-887-2822
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-26
Last Update Date:2010-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY003356225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant