Provider Demographics
NPI:1679789390
Name:CHOMYN, DAWN E (LMT)
Entity type:Individual
Prefix:MS
First Name:DAWN
Middle Name:E
Last Name:CHOMYN
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:39 BALSAM ST
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14610
Mailing Address - Country:US
Mailing Address - Phone:585-482-6778
Mailing Address - Fax:
Practice Address - Street 1:6605 PITTSFORD PALMYRA RD
Practice Address - Street 2:SUITE E-9
Practice Address - City:FAIRPORT
Practice Address - State:NY
Practice Address - Zip Code:14450
Practice Address - Country:US
Practice Address - Phone:585-223-0644
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY011238225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist