Provider Demographics
NPI:1871051458
Name:DAIGLE, LANIE A (PT)
Entity type:Individual
Prefix:
First Name:LANIE
Middle Name:A
Last Name:DAIGLE
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:LANIE
Other - Middle Name:A
Other - Last Name:YORK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:200 SOMERSET ST
Mailing Address - Street 2:
Mailing Address - City:MILLINOCKET
Mailing Address - State:ME
Mailing Address - Zip Code:04462-1298
Mailing Address - Country:US
Mailing Address - Phone:207-723-5161
Mailing Address - Fax:
Practice Address - Street 1:899 CENTRAL ST
Practice Address - Street 2:
Practice Address - City:MILLINOCKET
Practice Address - State:ME
Practice Address - Zip Code:04462-2125
Practice Address - Country:US
Practice Address - Phone:207-723-6450
Practice Address - Fax:207-723-3008
Is Sole Proprietor?:No
Enumeration Date:2019-03-04
Last Update Date:2019-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPT1556208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation