Provider Demographics
NPI:1346020708
Name:PRATT, DEANDRA LOREN (LMT)
Entity type:Individual
Prefix:
First Name:DEANDRA
Middle Name:LOREN
Last Name:PRATT
Suffix:
Gender:
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:168 MAIN ST FL 2
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON
Mailing Address - State:NY
Mailing Address - Zip Code:11743-6919
Mailing Address - Country:US
Mailing Address - Phone:631-836-3925
Mailing Address - Fax:
Practice Address - Street 1:168 MAIN STREET
Practice Address - Street 2:SECOND FLOOR
Practice Address - City:HUNTINGTON
Practice Address - State:NY
Practice Address - Zip Code:11743
Practice Address - Country:US
Practice Address - Phone:631-836-3925
Practice Address - Fax:631-836-3925
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-03
Last Update Date:2025-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY032891-01225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist