Provider Demographics
NPI:1598263428
Name:LANOUE, TAYLOR M (DPT)
Entity Type:Individual
Prefix:
First Name:TAYLOR
Middle Name:M
Last Name:LANOUE
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 1:81 MILLER ROAD
Mailing Address - Street 2:SUITE 400
Mailing Address - City:CASTLETON
Mailing Address - State:NY
Mailing Address - Zip Code:12033
Mailing Address - Country:US
Mailing Address - Phone:518-915-1452
Mailing Address - Fax:518-729-3181
Practice Address - Street 1:81 MILLER ROAD
Practice Address - Street 2:SUITE 400
Practice Address - City:CASTLETON
Practice Address - State:NY
Practice Address - Zip Code:12033
Practice Address - Country:US
Practice Address - Phone:518-915-1452
Practice Address - Fax:518-729-3181
Is Sole Proprietor?:No
Enumeration Date:2018-01-25
Last Update Date:2019-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY042401-1225100000X
NY042401225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist