Provider Demographics
NPI:1467433565
Name:SEYFARTH, ANNE MARIE (PT)
Entity Type:Individual
Prefix:MS
First Name:ANNE
Middle Name:MARIE
Last Name:SEYFARTH
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:ANNE
Other - Middle Name:MARIE
Other - Last Name:LANE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:700 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:MASSAPEQUA
Mailing Address - State:NY
Mailing Address - Zip Code:11758-2324
Mailing Address - Country:US
Mailing Address - Phone:516-797-7003
Mailing Address - Fax:516-797-7336
Practice Address - Street 1:700 BROADWAY
Practice Address - Street 2:
Practice Address - City:MASSAPEQUA
Practice Address - State:NY
Practice Address - Zip Code:11758-2324
Practice Address - Country:US
Practice Address - Phone:516-797-7003
Practice Address - Fax:516-797-7336
Is Sole Proprietor?:No
Enumeration Date:2005-11-07
Last Update Date:2009-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY6604225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY74250OtherVYTRA
NY4565846OtherAETNA
NY4565846OtherAETNA