Provider Demographics
NPI:1710178363
Name:PANA-LACSON, DOROTHY GAY (PT)
Entity Type:Individual
Prefix:
First Name:DOROTHY GAY
Middle Name:
Last Name:PANA-LACSON
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:DOROTHY GAY
Other - Middle Name:
Other - Last Name:PANA-LACSON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PT
Mailing Address - Street 1:8731 57TH RD
Mailing Address - Street 2:FLOOR 1
Mailing Address - City:ELMHURST
Mailing Address - State:NY
Mailing Address - Zip Code:11373-4856
Mailing Address - Country:US
Mailing Address - Phone:646-769-0675
Mailing Address - Fax:
Practice Address - Street 1:142-26 37TH AVE.
Practice Address - Street 2:#C
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11358
Practice Address - Country:US
Practice Address - Phone:718-359-6600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-08-08
Last Update Date:2013-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY029224225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist