Provider Demographics
NPI:1518232552
Name:BRICK SWANSON, LORRAINE
Entity Type:Individual
Prefix:MRS
First Name:LORRAINE
Middle Name:
Last Name:BRICK SWANSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3905 FRANKLIN AVE
Mailing Address - Street 2:
Mailing Address - City:SEAFORD
Mailing Address - State:NY
Mailing Address - Zip Code:11783-2300
Mailing Address - Country:US
Mailing Address - Phone:516-826-1112
Mailing Address - Fax:
Practice Address - Street 1:3905 FRANKLIN AVE
Practice Address - Street 2:
Practice Address - City:SEAFORD
Practice Address - State:NY
Practice Address - Zip Code:11783-2300
Practice Address - Country:US
Practice Address - Phone:516-826-1112
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-03-08
Last Update Date:2012-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY006778-1225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant