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General NPI Number Information
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NPI Number | 1487795514
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Entity Type | Individual
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Provider Name | ANTHONY EDWARD LODATO PT
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Gender | Male
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Dates
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Enumeration Date | 02/10/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 1303 ROANOKE AVE
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City | RIVERHEAD
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State | NY
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Zip | 11901-2748
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Country | US
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Telephone | 631-369-3694
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Fax | 631-369-3594
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Provider Business Mailing Address
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Address Line | 83 GROVE AVE
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City | PATCHOGUE
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State | NY
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Zip | 11772-4113
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Country | US
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Telephone | 631-758-7688
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Fax | 631-447-0919
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 017412
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License Number State | NY
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