Provider Demographics
NPI:1508597832
Name:LANZAFAME, NICOLE (PT, DPT)
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:
Last Name:LANZAFAME
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:961 PANORAMA TRL S
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14625-2311
Mailing Address - Country:US
Mailing Address - Phone:585-482-5060
Mailing Address - Fax:585-512-8372
Practice Address - Street 1:961 PANORAMA TRL S
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14625-2311
Practice Address - Country:US
Practice Address - Phone:585-482-5060
Practice Address - Fax:585-512-8372
Is Sole Proprietor?:No
Enumeration Date:2022-06-17
Last Update Date:2025-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY046197225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist