Provider Demographics
NPI:1982930475
Name:LAMANTIA, ANNALIESSE PATRICIA (PTA)
Entity Type:Individual
Prefix:MISS
First Name:ANNALIESSE
Middle Name:PATRICIA
Last Name:LAMANTIA
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 1:1200 DENNIS WAY
Mailing Address - Street 2:
Mailing Address - City:TORONTO
Mailing Address - State:OH
Mailing Address - Zip Code:43964-1080
Mailing Address - Country:US
Mailing Address - Phone:740-314-9608
Mailing Address - Fax:
Practice Address - Street 1:1200 DENNIS WAY
Practice Address - Street 2:
Practice Address - City:TORONTO
Practice Address - State:OH
Practice Address - Zip Code:43964-1080
Practice Address - Country:US
Practice Address - Phone:740-314-9608
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-10-19
Last Update Date:2009-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPTA07412225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant