Provider Demographics
NPI:1932698602
Name:LAKESIDE BALANCE AND WELLNESS, LLC
Entity Type:Organization
Organization Name:LAKESIDE BALANCE AND WELLNESS, LLC
Other - Org Name:FYZICAL THERAPY & BALANCE CANANDAIGUA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:DANIELLE
Authorized Official - Middle Name:E
Authorized Official - Last Name:LAROCCA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:585-394-8800
Mailing Address - Street 1:229 PARRISH ST STE 250
Mailing Address - Street 2:
Mailing Address - City:CANANDAIGUA
Mailing Address - State:NY
Mailing Address - Zip Code:14424-1795
Mailing Address - Country:US
Mailing Address - Phone:585-394-8800
Mailing Address - Fax:585-394-5942
Practice Address - Street 1:229 PARRISH ST STE 240
Practice Address - Street 2:
Practice Address - City:CANANDAIGUA
Practice Address - State:NY
Practice Address - Zip Code:14424-1791
Practice Address - Country:US
Practice Address - Phone:585-905-3405
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-05-08
Last Update Date:2019-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY037147225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty