Provider Demographics
NPI:1912663105
Name:LACON, CLAIRE
Entity Type:Individual
Prefix:
First Name:CLAIRE
Middle Name:
Last Name:LACON
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 1:475 ALLENDALE RD STE 206
Mailing Address - Street 2:
Mailing Address - City:KING OF PRUSSIA
Mailing Address - State:PA
Mailing Address - Zip Code:19406-1495
Mailing Address - Country:US
Mailing Address - Phone:862-339-4540
Mailing Address - Fax:
Practice Address - Street 1:1800 JOHN F KENNEDY BLVD STE 1800
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19103-7434
Practice Address - Country:US
Practice Address - Phone:215-634-9713
Practice Address - Fax:215-634-9714
Is Sole Proprietor?:No
Enumeration Date:2021-11-11
Last Update Date:2022-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT030001225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist