Provider Demographics
NPI:1790734416
Name:CLANCY, MAUREEN MARIE (PT DPT)
Entity Type:Individual
Prefix:MS
First Name:MAUREEN
Middle Name:MARIE
Last Name:CLANCY
Suffix:
Gender:F
Credentials:PT DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 EMMA LANE
Mailing Address - Street 2:SUITE 401
Mailing Address - City:CLIFTON PARK
Mailing Address - State:NY
Mailing Address - Zip Code:12065
Mailing Address - Country:US
Mailing Address - Phone:518-383-2610
Mailing Address - Fax:518-383-8188
Practice Address - Street 1:4 EMMA LANE
Practice Address - Street 2:SUITE 401
Practice Address - City:CLIFTON PARK
Practice Address - State:NY
Practice Address - Zip Code:12065
Practice Address - Country:US
Practice Address - Phone:518-383-2610
Practice Address - Fax:518-383-8188
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0229771225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYCC9748Medicare ID - Type Unspecified
P44946Medicare UPIN