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NPI Code Detail

MEDICARE: ANN F SLACK MSPT

MEDICARE: ANN F SLACK MSPT
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225100000XPhysical Therapist17203MA

General Provider Information

NPI Number : 1851372387
Entity Type Code : Individual
Provider Name (Legal Business Name) : ANN F SLACK MSPT
Provider Business Mailing Address
First Line : 29 CHURCH ST
Second Line :
City : LAKE PLACID
State : NY
Zip : 12946-1805
Country : US
Telephone Number : 518-523-8580
Fax Number : 518-523-7889
Provider Business Practice Location Address
First Line : 29 CHURCH ST
Second Line :
City : LAKE PLACID
State : NY
Zip : 12946-1805
Country : US
Telephone Number : 518-523-8580
Fax Number : 518-523-7889
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/10/2005
Last Update Date : 07/08/2007

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Directions to “ ANN F SLACK MSPT” Practice Location

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