Provider Demographics
NPI:1881639656
Name:LAXAMANA, MADELEIN ANNE (PT)
Entity Type:Individual
Prefix:
First Name:MADELEIN
Middle Name:ANNE
Last Name:LAXAMANA
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 1:708 SAW MILL RIVER RD
Mailing Address - Street 2:
Mailing Address - City:ARDSLEY
Mailing Address - State:NY
Mailing Address - Zip Code:10502-1810
Mailing Address - Country:US
Mailing Address - Phone:914-328-8077
Mailing Address - Fax:914-328-6083
Practice Address - Street 1:1 BRIDGE ST
Practice Address - Street 2:
Practice Address - City:ARDSLEY
Practice Address - State:NY
Practice Address - Zip Code:10502-2136
Practice Address - Country:US
Practice Address - Phone:914-639-8787
Practice Address - Fax:914-693-8525
Is Sole Proprietor?:No
Enumeration Date:2006-06-17
Last Update Date:2013-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY026247-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist