Provider Demographics
NPI:1518245901
Name:THREEHOUSE, ANNE GERALDINE (DPT)
Entity Type:Individual
Prefix:MRS
First Name:ANNE
Middle Name:GERALDINE
Last Name:THREEHOUSE
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:610 WAYNE ST
Mailing Address - Street 2:
Mailing Address - City:OLEAN
Mailing Address - State:NY
Mailing Address - Zip Code:14760-2355
Mailing Address - Country:US
Mailing Address - Phone:716-790-8418
Mailing Address - Fax:716-790-8447
Practice Address - Street 1:610 WAYNE ST
Practice Address - Street 2:
Practice Address - City:OLEAN
Practice Address - State:NY
Practice Address - Zip Code:14760-2355
Practice Address - Country:US
Practice Address - Phone:716-790-8418
Practice Address - Fax:716-790-8447
Is Sole Proprietor?:No
Enumeration Date:2011-08-02
Last Update Date:2019-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0338081225100000X
NY033808-1208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY562406112OtherTAX IDENTIFICATION NUMBER