Provider Demographics
NPI:1922746395
Name:SLOCUM, ANNE M (PTA)
Entity Type:Individual
Prefix:
First Name:ANNE
Middle Name:M
Last Name:SLOCUM
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11907 SHANE RD
Mailing Address - Street 2:
Mailing Address - City:CORNING
Mailing Address - State:NY
Mailing Address - Zip Code:14830-9316
Mailing Address - Country:US
Mailing Address - Phone:607-368-9624
Mailing Address - Fax:
Practice Address - Street 1:459 PHILO RD
Practice Address - Street 2:
Practice Address - City:ELMIRA
Practice Address - State:NY
Practice Address - Zip Code:14903-1051
Practice Address - Country:US
Practice Address - Phone:607-739-3581
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-25
Last Update Date:2022-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY05347-1225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant