Provider Demographics
NPI:1558678698
Name:LATHROP, JOHN (DPT)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:
Last Name:LATHROP
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3123 42ND ST
Mailing Address - Street 2:2F
Mailing Address - City:ASTORIA
Mailing Address - State:NY
Mailing Address - Zip Code:11103-3142
Mailing Address - Country:US
Mailing Address - Phone:860-334-9423
Mailing Address - Fax:347-642-9611
Practice Address - Street 1:3123 42ND ST
Practice Address - Street 2:2F
Practice Address - City:ASTORIA
Practice Address - State:NY
Practice Address - Zip Code:11103-3142
Practice Address - Country:US
Practice Address - Phone:860-334-9423
Practice Address - Fax:347-642-9611
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-10
Last Update Date:2014-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY032911225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist