Provider Demographics
NPI:1578531737
Name:LASWELL, MARTHA A (PT)
Entity Type:Individual
Prefix:
First Name:MARTHA
Middle Name:A
Last Name:LASWELL
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 HALFMOON EXCECUTIVE PARK DR
Mailing Address - Street 2:
Mailing Address - City:CLIFTON PARK
Mailing Address - State:NY
Mailing Address - Zip Code:12065
Mailing Address - Country:US
Mailing Address - Phone:518-371-6777
Mailing Address - Fax:518-383-9033
Practice Address - Street 1:1 HALFMOON EXCECUTIVE PARK DR
Practice Address - Street 2:
Practice Address - City:CLIFTON PARK
Practice Address - State:NY
Practice Address - Zip Code:12065
Practice Address - Country:US
Practice Address - Phone:518-371-6777
Practice Address - Fax:518-383-9033
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0103571225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01699343Medicaid
BB7224Medicare ID - Type Unspecified
S90020Medicare UPIN