Provider Demographics
NPI:1821194663
Name:RIGDON, LAURIS SEAN (PT)
Entity Type:Individual
Prefix:MR
First Name:LAURIS
Middle Name:SEAN
Last Name:RIGDON
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8390 OSWEGO RD
Mailing Address - Street 2:
Mailing Address - City:LIVERPOOL
Mailing Address - State:NY
Mailing Address - Zip Code:13090-1002
Mailing Address - Country:US
Mailing Address - Phone:315-635-5000
Mailing Address - Fax:315-622-1110
Practice Address - Street 1:8390 OSWEGO RD
Practice Address - Street 2:
Practice Address - City:LIVERPOOL
Practice Address - State:NY
Practice Address - Zip Code:13090-1002
Practice Address - Country:US
Practice Address - Phone:315-635-5000
Practice Address - Fax:315-492-1203
Is Sole Proprietor?:No
Enumeration Date:2006-09-16
Last Update Date:2024-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY020543225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYDD5847Medicare ID - Type Unspecified
NYP90269Medicare UPIN