Provider Demographics
NPI:1396031373
Name:LANAM, JEFFREY D (LPT)
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:D
Last Name:LANAM
Suffix:
Gender:M
Credentials:LPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1325 CHURCHILL HUBBARD RD
Mailing Address - Street 2:
Mailing Address - City:YOUNGSTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:44505-1346
Mailing Address - Country:US
Mailing Address - Phone:330-759-5904
Mailing Address - Fax:330-759-8709
Practice Address - Street 1:1325 CHURCHILL HUBBARD RD
Practice Address - Street 2:
Practice Address - City:YOUNGSTOWN
Practice Address - State:OH
Practice Address - Zip Code:44505-1346
Practice Address - Country:US
Practice Address - Phone:330-759-5904
Practice Address - Fax:330-759-8709
Is Sole Proprietor?:No
Enumeration Date:2011-06-28
Last Update Date:2011-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPT013305225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2577162Medicaid
OH366731Medicare Oscar/Certification