Provider Demographics
NPI:1548445448
Name:TITUS, LANAE (LMT)
Entity type:Individual
Prefix:
First Name:LANAE
Middle Name:
Last Name:TITUS
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:LONI
Other - Middle Name:
Other - Last Name:TITUS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LMT
Mailing Address - Street 1:PO BOX 152
Mailing Address - Street 2:
Mailing Address - City:MENDON
Mailing Address - State:NY
Mailing Address - Zip Code:14506-0152
Mailing Address - Country:US
Mailing Address - Phone:585-748-5558
Mailing Address - Fax:
Practice Address - Street 1:20 ASSEMBLY DR.
Practice Address - Street 2:SUITE 101
Practice Address - City:MENDON
Practice Address - State:NY
Practice Address - Zip Code:14506-0152
Practice Address - Country:US
Practice Address - Phone:585-748-5558
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-09
Last Update Date:2008-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY012867-1225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist