Provider Demographics
NPI:1487795514
Name:LODATO, ANTHONY EDWARD (PT)
Entity type:Individual
Prefix:
First Name:ANTHONY
Middle Name:EDWARD
Last Name:LODATO
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:83 GROVE AVE
Mailing Address - Street 2:
Mailing Address - City:PATCHOGUE
Mailing Address - State:NY
Mailing Address - Zip Code:11772-4113
Mailing Address - Country:US
Mailing Address - Phone:631-758-7688
Mailing Address - Fax:631-447-0919
Practice Address - Street 1:1303 ROANOKE AVE
Practice Address - Street 2:
Practice Address - City:RIVERHEAD
Practice Address - State:NY
Practice Address - Zip Code:11901-2748
Practice Address - Country:US
Practice Address - Phone:631-369-3694
Practice Address - Fax:631-369-3594
Is Sole Proprietor?:No
Enumeration Date:2007-02-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY017412225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist