Provider Demographics
NPI:1548643638
Name:PERCOCO, LAUREN (DPT)
Entity type:Individual
Prefix:MRS
First Name:LAUREN
Middle Name:
Last Name:PERCOCO
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:MS
Other - First Name:LAUREN
Other - Middle Name:
Other - Last Name:ENGEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:8 JOANNE DR
Mailing Address - Street 2:
Mailing Address - City:HOLBROOK
Mailing Address - State:NY
Mailing Address - Zip Code:11741-5603
Mailing Address - Country:US
Mailing Address - Phone:631-848-7122
Mailing Address - Fax:
Practice Address - Street 1:8 JOANNE DR
Practice Address - Street 2:
Practice Address - City:HOLBROOK
Practice Address - State:NY
Practice Address - Zip Code:11741-5603
Practice Address - Country:US
Practice Address - Phone:631-848-7122
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-07
Last Update Date:2015-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY033933225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist