Provider Demographics
NPI:1629056833
Name:LANZA, DONNA (PT)
Entity Type:Individual
Prefix:
First Name:DONNA
Middle Name:
Last Name:LANZA
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 1:691 ROUTE 25A
Mailing Address - Street 2:BLDG 15
Mailing Address - City:MILLER PLACE
Mailing Address - State:NY
Mailing Address - Zip Code:11764-2643
Mailing Address - Country:US
Mailing Address - Phone:631-332-1779
Mailing Address - Fax:631-982-5650
Practice Address - Street 1:691 ROUTE 25A
Practice Address - Street 2:BLDG 15
Practice Address - City:MILLER PLACE
Practice Address - State:NY
Practice Address - Zip Code:11764-2643
Practice Address - Country:US
Practice Address - Phone:631-332-1779
Practice Address - Fax:631-982-5650
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-06
Last Update Date:2010-09-23
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY14510225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYQ38961Medicare PIN
NYQ38961Medicare Oscar/Certification