Provider Demographics
NPI:1336306455
Name:ZEGARELLI, LORRELL HEATHER (ATC)
Entity type:Individual
Prefix:
First Name:LORRELL
Middle Name:HEATHER
Last Name:ZEGARELLI
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16 OGDEN RD
Mailing Address - Street 2:
Mailing Address - City:WEST ISLIP
Mailing Address - State:NY
Mailing Address - Zip Code:11795-3907
Mailing Address - Country:US
Mailing Address - Phone:631-539-7216
Mailing Address - Fax:
Practice Address - Street 1:90 EAST SHORE ROAD INSIDE EQUINOX
Practice Address - Street 2:PROFESSIONAL ORTHOPEDIC AND SPORTS PHYSICAL THERAPY
Practice Address - City:GREAT NECK
Practice Address - State:NY
Practice Address - Zip Code:11023
Practice Address - Country:US
Practice Address - Phone:516-684-1122
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-16
Last Update Date:2008-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0009372255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer