MEDICARE: MRS. JACQUELINE LOUISE LAMONT PTA

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
1	225200000X	Physical Therapy Assistant	X007360-1	NY

General Provider Information

NPI Number	:	1205167574
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. JACQUELINE LOUISE LAMONT PTA

Provider Business Mailing Address
First Line	:	18 BROAD. ST - HCA
Second Line	:
City	:	JOHNSON CITY
State	:	NY
Zip	:	13790-2198
Country	:	US
Telephone Number	:	607-798-7117
Fax Number	:	607-798-0074

Provider Business Practice Location Address
First Line	:	18 BROAD ST.
Second Line	:
City	:	JOHNSON CITY
State	:	NY
Zip	:	13790-2198
Country	:	US
Telephone Number	:	607-798-7117
Fax Number	:	607-798-0074

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/26/2010
Last Update Date	:	07/15/2021

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