Provider Demographics
NPI:1376351353
Name:LAMMON, MAUREEN M
Entity type:Individual
Prefix:
First Name:MAUREEN
Middle Name:M
Last Name:LAMMON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 OXFORD RD
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:NY
Mailing Address - Zip Code:12180-7069
Mailing Address - Country:US
Mailing Address - Phone:518-691-1931
Mailing Address - Fax:
Practice Address - Street 1:EDDY VILLAGE GREEN 200 VILLAGE GREEN DRIVE
Practice Address - Street 2:
Practice Address - City:COHOES
Practice Address - State:NY
Practice Address - Zip Code:12047
Practice Address - Country:US
Practice Address - Phone:518-669-1931
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-23
Last Update Date:2024-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY013991-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist