Provider Demographics
NPI:1649327206
Name:MCMENEMY, LAURIE ANN (PTA)
Entity type:Individual
Prefix:MS
First Name:LAURIE
Middle Name:ANN
Last Name:MCMENEMY
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 1:3025 MCCORKINDALE RD
Mailing Address - Street 2:
Mailing Address - City:CALEDONIA
Mailing Address - State:NY
Mailing Address - Zip Code:14423-9616
Mailing Address - Country:US
Mailing Address - Phone:585-538-4410
Mailing Address - Fax:
Practice Address - Street 1:WYOMING COUNTY COMMUNITY HOSPITAL
Practice Address - Street 2:400 NORTH MAIN ST
Practice Address - City:WARSAW
Practice Address - State:NY
Practice Address - Zip Code:14569
Practice Address - Country:US
Practice Address - Phone:585-786-2233
Practice Address - Fax:585-786-1275
Is Sole Proprietor?:No
Enumeration Date:2007-01-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY002959-1225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant