Healthcare Provider Details

I. General information

NPI: 1497753230
Provider Name (Legal Business Name): KARA KORFONTA PT
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 07/13/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 KIRKLAND AVE SUITE 201/202
CLINTON NY
13323-1426
US

IV. Provider business mailing address

1 KIRKLAND AVE SUITE 201/202
CLINTON NY
13323-1426
US

V. Phone/Fax

Practice location:
  • Phone: 315-853-1401
  • Fax: 315-853-7629
Mailing address:
  • Phone: 315-853-1401
  • Fax: 315-853-7629

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number022650-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: