Provider Demographics
NPI:1497404388
Name:DENNIS, AMMON (LMT)
Entity Type:Individual
Prefix:
First Name:AMMON
Middle Name:
Last Name:DENNIS
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:312 BEACH 89TH ST APT 3
Mailing Address - Street 2:
Mailing Address - City:ROCKAWAY BEACH
Mailing Address - State:NY
Mailing Address - Zip Code:11693-1404
Mailing Address - Country:US
Mailing Address - Phone:646-327-3942
Mailing Address - Fax:
Practice Address - Street 1:312 BEACH 89TH ST APT 3
Practice Address - Street 2:
Practice Address - City:ROCKAWAY BEACH
Practice Address - State:NY
Practice Address - Zip Code:11693-1404
Practice Address - Country:US
Practice Address - Phone:646-327-3942
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-20
Last Update Date:2022-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY032385-01225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty