Provider Demographics
NPI:1023615945
Name:O'CONNOR, KATHRYN ANNE LANG (DPT)
Entity type:Individual
Prefix:DR
First Name:KATHRYN
Middle Name:ANNE LANG
Last Name:O'CONNOR
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:34 THE WATERWAY
Mailing Address - Street 2:
Mailing Address - City:MANHASSET
Mailing Address - State:NY
Mailing Address - Zip Code:11030-1330
Mailing Address - Country:US
Mailing Address - Phone:516-428-3359
Mailing Address - Fax:
Practice Address - Street 1:34 THE WATERWAY
Practice Address - Street 2:
Practice Address - City:MANHASSET
Practice Address - State:NY
Practice Address - Zip Code:11030-1330
Practice Address - Country:US
Practice Address - Phone:516-428-3359
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-04
Last Update Date:2020-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY046421225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty