MEDICARE: MS. JONNA KATHLEEN DEBLOIS PHYSICAL THERAPIST

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	018085-1	NY

General Provider Information

NPI Number	:	1205817574
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. JONNA KATHLEEN DEBLOIS PHYSICAL THERAPIST

Provider Business Mailing Address
First Line	:	875 OLD COUNTRY RD STE 153LL
Second Line	:
City	:	PLAINVIEW
State	:	NY
Zip	:	11803-4942
Country	:	US
Telephone Number	:	516-935-1958
Fax Number	:	516-681-5463

Provider Business Practice Location Address
First Line	:	875 OLD COUNTRY RD STE 153LL
Second Line	:
City	:	PLAINVIEW
State	:	NY
Zip	:	11803-4942
Country	:	US
Telephone Number	:	516-935-1958
Fax Number	:	516-827-0714

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/14/2005
Last Update Date	:	09/20/2023

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