Provider Demographics
NPI:1215088547
Name:LANNON, PATRICE ANN (PT,CHT)
Entity type:Individual
Prefix:MS
First Name:PATRICE
Middle Name:ANN
Last Name:LANNON
Suffix:
Gender:F
Credentials:PT,CHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:96 ROCK MAJOR RD
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06824-3922
Mailing Address - Country:US
Mailing Address - Phone:203-451-6469
Mailing Address - Fax:
Practice Address - Street 1:96 ROCK MAJOR RD
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:CT
Practice Address - Zip Code:06824-3922
Practice Address - Country:US
Practice Address - Phone:203-451-6469
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-15
Last Update Date:2008-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT002315225100000X, 2251H1200X
NY0057134225100000X, 2251H1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2251H1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistHand
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTZS605OtherOXFORD
CT080002315CT01OtherANTHEM BLUE CROSS