Healthcare Provider Details

I. General information

NPI: 1760438014
Provider Name (Legal Business Name): CINDY LEE LACK PT
Entity Type: Individual
Gender: Female
Sole Proprietor: X

Provider Other Name: CINDY LEE LANZ PT

II. Dates (important events)

Enumeration Date: 05/26/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 WHIPPLE LANE
ROCHESTER NY
14622
US

IV. Provider business mailing address

60 ARMETALE LUSTER
WEBSTER NY
14580
US

V. Phone/Fax

Practice location:
  • Phone: 585-338-3070
  • Fax: 585-336-5014
Mailing address:
  • Phone: 585-670-9306
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number0232021
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code2251S0007X
TaxonomySports Physical Therapist
License Number0232021
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number0232021
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: