Provider Demographics
NPI:1265720338
Name:LAMPE, MARY LISA (PT)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:LISA
Last Name:LAMPE
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 1:60 GOLDENS BRIDGE RD
Mailing Address - Street 2:
Mailing Address - City:KATONAH
Mailing Address - State:NY
Mailing Address - Zip Code:10536-3447
Mailing Address - Country:US
Mailing Address - Phone:914-232-3266
Mailing Address - Fax:914-232-3255
Practice Address - Street 1:666 LEXINGTON AVE
Practice Address - Street 2:
Practice Address - City:MOUNT KISCO
Practice Address - State:NY
Practice Address - Zip Code:10549-3632
Practice Address - Country:US
Practice Address - Phone:914-666-7900
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-11
Last Update Date:2011-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY013963-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty